| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $647 | $323.5 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,604 | $802 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $3,204 | $1,602 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $4,813 | $2,406.5 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $9,483 | $4,741.5 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $16,752 | $8,376 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $6,318 | $3,159 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $7,571 | $3,785.5 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $9,935 | $4,967.5 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $5,408 | $2,704 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $11,104 | $5,552 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $13,013 | $6,506.5 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $15,133 | $7,566.5 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $665 | $332.5 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $812 | $406 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,191 | $595.5 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $7,904 | $3,952 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $9,460 | $4,730 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $11,834 | $5,917 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $10,711 | $5,355.5 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $11,659 | $5,829.5 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $13,172 | $6,586 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,527 | $763.5 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $7,906 | $3,953 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $5,647 | $2,823.5 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $7,906 | $3,953 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $11,104 | $5,552 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $11,895 | $5,947.5 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $11,895 | $5,947.5 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $13,663 | $6,831.5 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $15,133 | $7,566.5 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $15,133 | $7,566.5 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $5,647 | $2,823.5 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $6,541 | $3,270.5 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,437 | $718.5 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,191 | $595.5 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,026 | $513 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $10,317 | $5,158.5 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $11,104 | $5,552 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,117 | $558.5 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,184 | $592 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $10,710 | $5,355 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $11,104 | $5,552 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $7,951 | $3,975.5 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $9,158 | $4,579 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $11,931 | $5,965.5 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $7,573 | $3,786.5 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $9,158 | $4,579 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $11,363 | $5,681.5 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $10,711 | $5,355.5 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $13,172 | $6,586 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,778 | $1,889 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,830 | $1,415 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $4,156 | $2,078 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $3,305 | $1,652.5 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $3,305 | $1,652.5 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,830 | $1,415 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,131 | $565.5 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,876 | $2,438 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $8,573 | $4,286.5 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $14,548 | $7,274 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $546 | $273 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $333 | $166.5 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $975 | $487.5 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $701 | $350.5 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $626 | $313 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $1,122 | $561 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $579 | $289.5 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $244 | $122 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $128 | $64 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $258 | $129 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $339 | $169.5 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $859 | $429.5 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $244 | $122 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $203 | $101.5 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $61 | $30.5 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $579 | $289.5 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,999 | $999.5 | — | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $13,116 | $6,558 | — | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $164 | $82 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $207 | $103.5 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $218 | $109 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $242 | $121 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $311 | $155.5 | — | — | — | — |
| preventive |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,865 | $1,432.5 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| 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 | $942 | $471 | — | — | — | — |
| 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 | $19,842 | $9,921 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $19,532 | $9,766 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $32,843 | $16,422 | — | — | — | — |