| behavioral |
| Psychoses | MS-DRG | 885 | 11 | — | — | $1,188 | $11,361 | $27,485 |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $660 | $429 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $987 | $641.55 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,556 | $1,011.4 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,334 | $1,517.1 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,911 | $2,542.15 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,946 | $3,214.9 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,762 | $1,795.3 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,630 | $1,709.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,388 | $1,552.2 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $5,059 | $3,288.35 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,146 | $2,694.9 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,486 | $2,265.9 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $270 | $175.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $718 | $466.7 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $827 | $537.55 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,630 | $1,709.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,190 | $2,723.5 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,190 | $2,723.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,696 | $3,052.4 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $471 | $306.15 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,630 | $1,709.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,973 | $1,282.45 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,143 | $2,042.95 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $5,225 | $3,396.25 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,976 | $3,234.4 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,146 | $2,694.9 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,486 | $2,265.9 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,486 | $2,265.9 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,630 | $1,709.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $425 | $276.25 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $386 | $250.9 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $623 | $404.95 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,764 | $2,446.6 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,220 | $2,743 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $424 | $275.6 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $558 | $362.7 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,764 | $2,446.6 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,220 | $2,743 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,973 | $1,282.45 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,901 | $3,185.65 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,901 | $3,185.65 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,757 | $2,442.05 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,764 | $2,446.6 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,220 | $2,743 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,432 | $930.8 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,336 | $868.4 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,764 | $1,146.6 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,288 | $837.2 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,288 | $837.2 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,366 | $887.9 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,439 | $935.35 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,227 | $797.55 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,745 | $1,134.25 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $629 | $408.85 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $710 | $461.5 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $480 | $312 | — | — | — |
| EKG tracing only | CPT | 93005 | 3 | $15,025 | $9,015.04 | $82.19 | $635.14 | $1,186.64 |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,365 | $2,187.25 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,896 | $1,232.4 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,944 | $1,263.6 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 11 | — | — | $11,603 | $37,793 | $39,570 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 11 | — | — | $5,829.43 | $18,987 | $23,448 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 9 | — | — | $1,980 | $6,469.22 | $13,467 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 11 | — | — | $9,016.78 | $27,316 | $29,368 |
| COPD w MCC | MS-DRG | 190 | 11 | — | — | $6,391.43 | $17,899 | $21,796 |
| COPD w CC | MS-DRG | 191 | 6 | — | — | $4,864.11 | $7,594.85 | $16,588 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 13 | — | — | $4,650.04 | $15,009 | $15,858 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 7 | — | — | $1,980 | $10,197 | $12,367 |
| AMI discharged alive w MCC | MS-DRG | 280 | 13 | — | — | $7,353 | $12,997 | $31,564 |
| AMI discharged alive w CC | MS-DRG | 281 | 11 | — | — | $1,980 | $10,301 | $21,784 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 12 | — | — | $1,980 | $7,994 | $19,326 |
| Heart failure & shock w MCC | MS-DRG | 291 | 11 | — | — | $7,407.53 | $19,954 | $25,261 |
| Heart failure & shock w CC | MS-DRG | 292 | 10 | — | — | $4,898.73 | $7,881.7 | $16,706 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 11 | — | — | $6,947.08 | $22,149 | $23,691 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 11 | — | — | $1,980 | $7,303.27 | $14,476 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 11 | — | — | $1,980 | $6,965 | $11,139 |
| GI hemorrhage w CC | MS-DRG | 378 | 11 | — | — | $5,658.64 | $18,430 | $19,297 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 8 | — | — | $1,980 | $7,144.88 | $15,340 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 11 | — | — | $1,980 | $19,301 | $45,186 |
| Kidney/UTI w MCC | MS-DRG | 689 | 11 | — | — | $5,738 | $10,780 | $22,831 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 11 | — | — | $4,670.82 | $7,499.85 | $15,929 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 11 | — | — | $11,208 | $35,748 | $38,223 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 8 | — | — | $5,904.44 | $18,766 | $20,135 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $330 | $214.5 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $317 | $206.05 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $380 | $247 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $191 | $124.15 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $109 | $70.85 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $317 | $206.05 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $96 | $62.4 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $125 | $81.25 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $141 | $91.65 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $293 | $190.45 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $180 | $117 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $116 | $75.4 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $150 | $97.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $968 | $629.2 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 3 | $1,204.67 | $722.8 | $190.93 | $197.62 | $200.48 |
| Vaginal delivery only | CPT | 59409 | 0 | $3,074 | $1,998.1 | — | — | — |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 3 | — | — | $5,510.61 | $5,648.38 | $5,786.14 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $363 | $235.95 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $321 | $208.65 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $344 | $223.6 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $387 | $251.55 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $174 | $113.1 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $302 | $196.3 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $257 | $167.05 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $313 | $203.45 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $369 | $239.85 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 3 | $9,633 | $5,779.8 | $856.58 | $886.56 | $899.41 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 3 | $11,744 | $7,046.45 | $856.58 | $1,812.26 | $1,902.87 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 3 | $9,867.32 | $5,920.39 | $878.27 | $909.01 | $922.19 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 2 | $10,230 | $6,138.14 | $878.27 | $878.27 | $922.19 |
| Colonoscopy diagnostic | CPT | 45378 | 3 | $10,230 | $6,138.14 | $878.27 | $909.01 | $922.19 |
| Colonoscopy with biopsy | CPT | 45380 | 3 | $15,105 | $9,063.27 | $1,130.13 | $1,169.69 | $1,186.64 |
| Colonoscopy with polyp removal | CPT | 45385 | 3 | $14,146 | $8,487.89 | $1,130.13 | $1,169.69 | $1,186.64 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 2 | $84,995 | $50,997 | $16,559 | $16,559 | $17,387 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 3 | — | — | $5,996.6 | $6,146.52 | $6,296.43 |
| Total hip replacement | CPT | 27130 | 3 | $64,375 | $38,625 | $12,125 | $12,337 | $12,731 |
| Total knee replacement | CPT | 27447 | 3 | $71,466 | $42,880 | $12,125 | $12,125 | $12,731 |
| Knee revision arthroplasty single component | CPT | 27486 | 1 | $55,750 | $33,450 | $12,550 | $12,550 | $12,550 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 3 | $46,126 | $27,675 | $6,852.93 | $7,092.78 | $7,195.57 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 3 | $53,251 | $31,950 | $6,852.93 | $7,092.78 | $7,195.57 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 3 | $68,982 | $41,389 | $3,090.15 | $3,244.66 | $12,731 |
| ACL reconstruction | CPT | 29888 | 3 | $75,580 | $45,348 | $6,852.93 | $7,195.57 | $12,731 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 11 | — | — | $26,522 | $79,097 | $90,445 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 11 | — | — | $13,832 | $45,051 | $50,001 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 9 | — | — | $1,980 | $31,627 | $38,882 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 11 | — | — | $1,980 | $31,790 | $36,416 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 10 | — | — | $1,980 | $11,305 | $26,875 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 3 | — | — | $4,713.34 | $6,574.77 | $17,462 |
| Laparoscopic appendectomy | CPT | 44970 | 2 | $31,073 | $18,644 | $5,709.53 | $5,709.53 | $5,995.01 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 10 | — | — | $1,980 | $19,079 | $41,937 |
| Laparoscopic cholecystectomy | CPT | 47562 | 2 | $30,262 | $18,157 | $5,709.53 | $5,709.53 | $5,995.01 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 2 | $32,231 | $19,338 | $5,709.53 | $5,709.53 | $5,995.01 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 10 | — | — | $16,804 | $54,731 | $74,433 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 11 | — | — | $12,085 | $39,362 | $54,426 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 11 | — | — | $9,410.87 | $17,934 | $39,625 |
| Lap inguinal hernia repair | CPT | 49650 | 3 | $54,019 | $32,411 | $5,709.53 | $5,909.36 | $5,995.01 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 3 | $42,595 | $25,557 | $10,039 | $10,390 | $10,541 |
| Lap salpingo-oophorectomy | CPT | 58661 | 3 | $52,828 | $31,697 | $5,709.53 | $5,909.36 | $5,995.01 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 3 | — | — | $10,041 | $10,292 | $10,543 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 11 | — | — | $7,158.84 | $23,316 | $26,314 |
| Left heart catheterization | CPT | 93452 | 0 | $7,469 | $4,854.85 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $17,157 | $11,152 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $14,957 | $9,722.05 | — | — | — |