| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $20 | $12 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $20 | $12 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $20 | $12 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $20 | $12 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $170.16 | $102.1 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $316.51 | $189.91 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $588.69 | $353.21 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,095 | $657 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,036.64 | $1,221.98 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,168.54 | $1,901.12 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,489.56 | $1,493.74 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,077.03 | $1,246.22 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,800 | $1,680 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,174.59 | $1,304.75 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,815.96 | $1,689.58 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,165.21 | $1,899.13 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,063.3 | $2,437.98 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $287.44 | $172.46 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $350.51 | $210.31 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $359.08 | $215.45 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,879.93 | $1,127.96 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,313.78 | $1,388.27 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,701.87 | $1,621.12 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,700.81 | $1,620.49 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $735 | $441 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,862.19 | $2,317.31 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $426.79 | $256.07 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,116.22 | $1,269.73 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,051.42 | $1,230.85 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,119.41 | $1,271.65 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,923.06 | $1,753.84 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,891.73 | $1,735.04 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,936.79 | $1,762.07 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,198.86 | $1,919.32 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,117.62 | $2,470.57 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,152.15 | $2,491.29 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,909.25 | $1,145.55 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,287.83 | $1,372.7 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $384.76 | $230.86 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $339.79 | $203.87 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $368.72 | $221.23 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,763.04 | $1,657.82 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,685.47 | $2,211.28 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $328.19 | $196.91 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $370.9 | $222.54 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,778.21 | $1,666.93 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,757.78 | $2,254.67 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,950.08 | $1,170.05 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,364.93 | $1,418.96 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,783.56 | $1,670.14 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,030.95 | $2,418.57 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,449.9 | $2,669.94 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,086.2 | $3,051.72 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,772.27 | $1,663.36 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,675 | $2,205 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $997.52 | $598.51 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $657.65 | $394.59 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $668.58 | $401.15 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $791.91 | $475.15 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $747.42 | $448.45 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $710.82 | $426.49 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $831.09 | $498.65 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $741.8 | $445.08 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $186.64 | $111.98 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $232.45 | $139.47 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $232.45 | $139.47 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $366.03 | $219.62 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,494.41 | $1,496.65 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,317.65 | $790.59 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,520.35 | $1,512.21 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 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 | $112.66 | $67.6 | — | — | — |
| General health panel | CPT | 80050 | 0 | $175 | $105 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $75.08 | $45.05 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $149.59 | $89.75 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $149.59 | $89.75 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $248.46 | $149.08 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $90.13 | $54.08 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $39.16 | $23.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $80.92 | $48.55 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $61.97 | $37.18 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $46.34 | $27.8 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $110.07 | $66.04 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $99.95 | $59.97 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $98.47 | $59.08 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $151.23 | $90.74 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $38.49 | $23.09 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $170.8 | $102.48 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $433.26 | $259.96 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,987.68 | $2,392.61 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $260.96 | $156.58 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $307.56 | $184.54 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $332.32 | $199.39 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $500.17 | $300.1 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $131.27 | $78.76 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $173.97 | $104.38 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $205.04 | $123.02 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $221.55 | $132.93 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $289.82 | $173.89 | — | — | — |
| 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 | — | — | — | — | — |
| 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 | $9,159.88 | $5,495.93 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $13,888 | $8,332.97 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $13,888 | $8,332.97 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $9,819.54 | $5,891.72 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $13,087 | $7,852.4 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $11,645 | $6,986.99 | — | — | — |
