| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $218 | $154.78 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $607 | $430.97 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $667 | $473.57 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,431 | $1,016.01 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,119 | $1,504.49 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,292 | $2,337.32 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,521 | $3,209.91 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,727 | $1,936.17 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,189 | $2,264.19 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,510 | $2,492.1 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,375 | $2,396.25 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,475 | $3,177.25 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,905 | $3,482.55 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,115 | $4,341.65 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $294 | $208.74 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $357 | $253.47 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $404 | $286.84 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,255 | $2,311.05 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,903 | $2,771.13 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,482 | $3,182.22 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,592 | $2,550.32 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,528 | $3,214.88 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $711 | $504.81 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $3,282 | $2,330.22 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,869 | $2,036.99 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,186 | $2,262.06 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,658 | $3,307.18 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,045 | $2,161.95 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,737 | $3,363.27 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,651 | $4,012.21 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $6,649 | $4,720.79 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $6,567 | $4,662.57 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,993 | $2,125.03 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,530 | $2,506.3 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $642 | $455.82 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $368 | $261.28 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $684 | $485.64 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,113 | $3,630.23 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $6,387 | $4,534.77 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $460 | $326.6 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $615 | $436.65 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $5,002 | $3,551.42 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,486 | $4,605.06 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,458 | $2,455.18 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,975 | $2,822.25 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,834 | $3,432.14 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $5,767 | $4,094.57 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $6,811 | $4,835.81 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $8,275 | $5,875.25 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,896 | $3,476.16 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,546 | $4,647.66 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,811 | $1,285.81 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,320 | $937.2 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $792 | $562.32 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,088 | $772.48 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,500 | $1,065 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,633 | $1,159.43 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,090 | $773.9 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,245 | $883.95 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $941 | $668.11 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $472 | $335.12 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $585 | $415.35 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $414 | $293.94 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $498 | $353.58 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,368 | $1,681.28 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,407 | $998.97 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,834 | $1,302.14 | — | — | — |
| 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 | $313 | $222.23 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $146 | $103.66 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $366 | $259.86 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $165 | $117.15 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $193 | $137.03 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $285 | $202.35 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $65 | $46.15 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $129 | $91.59 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $67 | $47.57 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $122 | $86.62 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $197 | $139.87 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $171 | $121.41 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $123 | $87.33 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $144 | $102.24 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $115 | $81.65 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $617 | $438.07 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $817 | $580.07 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $8,311 | $5,900.81 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $426 | $302.46 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $552 | $391.92 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $697 | $494.87 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $999 | $709.29 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $344 | $244.24 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $364 | $258.44 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $426 | $302.46 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $552 | $391.92 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $697 | $494.87 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | — | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | — | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | — | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | — | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | — | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | — | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | — | — | — | — | — |
| surgery |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | — | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | — | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | — | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 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 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 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 | — | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 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 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | — | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | — | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 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 | — | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | — | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | — | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $1,111 | $788.81 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 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 | $24,276 | $17,236 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $37,656 | $26,736 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $14,920 | $10,593 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $18,697 | $13,275 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $19,828 | $14,078 | — | — | — |
