| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $22,145 | $5,469.71 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $492.91 | $121.75 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $914.28 | $225.83 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,524.4 | $376.53 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,153.36 | $596.92 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,745.5 | $925.14 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,144.49 | $1,270.69 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $4,697.25 | $1,174.31 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $5,439.65 | $1,359.91 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $6,180.46 | $1,545.12 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $5,893.37 | $1,473.34 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $9,865.73 | $2,466.43 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $13,123 | $3,280.66 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $13,429 | $3,357.21 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $989.06 | $247.27 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $1,276.1 | $319.03 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,016.37 | $254.09 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $6,860.32 | $1,715.08 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $7,545.21 | $1,886.3 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $9,532.81 | $2,383.2 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $7,615.59 | $1,903.9 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $8,476.82 | $2,119.21 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $11,047 | $2,761.71 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,666.41 | $416.6 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $5,464.89 | $1,366.22 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $7,532.23 | $1,883.06 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $7,139.9 | $1,784.98 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $8,659.28 | $2,164.82 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $9,297.06 | $2,324.27 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $9,297.06 | $2,324.27 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $12,575 | $3,143.78 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $12,575 | $3,143.78 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $12,575 | $3,143.78 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $6,088.64 | $1,522.16 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $6,700.38 | $1,675.1 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,293.87 | $323.47 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,118.21 | $279.55 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,308.87 | $327.22 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $10,210 | $2,552.38 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $13,403 | $3,350.7 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,280.91 | $320.23 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,315.06 | $328.77 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $10,068 | $2,517.01 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $13,403 | $3,350.7 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $7,238.33 | $1,809.58 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $9,041.4 | $2,260.35 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $9,946.39 | $2,486.6 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $13,328 | $3,331.91 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $15,742 | $3,935.62 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $18,050 | $4,512.5 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $9,614.87 | $2,403.72 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $11,047 | $2,761.71 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $3,027.22 | $756.81 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,783.93 | $695.98 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,783.93 | $695.98 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,498.95 | $374.74 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,107.92 | $526.98 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $2,677.28 | $669.32 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $3,143.43 | $785.86 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,783.93 | $695.98 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,783.93 | $695.98 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,165.87 | $291.47 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,426.46 | $356.62 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $924.78 | $231.2 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $918.07 | $226.76 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $6,086.35 | $1,521.59 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $3,371.77 | $842.94 | — | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $39,436 | $9,740.81 | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $35,341 | $8,729.23 | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $28,852 | $7,126.5 | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $15,311 | $3,781.78 | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $46,046 | $11,373 | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $15,907 | $3,928.97 | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $57,865 | $14,293 | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $50,192 | $12,397 | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $50,259 | $12,414 | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $31,862 | $7,870.03 | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $33,243 | $8,211.13 | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | $23,668 | $5,845.95 | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $40,896 | $10,101 | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $31,037 | $7,666.16 | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $22,001 | $5,434.25 | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $62,158 | $15,353 | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $27,778 | $6,861.2 | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $35,727 | $8,824.62 | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | $84,174 | $20,791 | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $38,915 | $9,611.99 | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $32,115 | $7,932.52 | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $52,988 | $13,088 | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $40,322 | $9,959.45 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $460.19 | $113.67 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $160.61 | $39.67 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $616.44 | $152.26 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $311.12 | $76.85 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $674.82 | $166.68 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $938.17 | $231.73 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $144.69 | $35.74 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $14.52 | $3.59 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $122.03 | $30.14 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $232.01 | $57.31 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $264.35 | $65.29 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $185.22 | $45.75 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $247.45 | $61.12 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $222.71 | $55.01 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $136.75 | $34.19 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $626.98 | $156.75 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $995.17 | $245.81 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $1,271.07 | $313.95 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $1,616.62 | $399.31 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $2,387.28 | $589.66 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $825.85 | $203.98 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $995.17 | $245.81 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $995.17 | $245.81 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $1,271.07 | $313.95 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,616.62 | $399.31 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $8,002.37 | $1,976.59 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $9,261.1 | $2,287.49 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $8,850.23 | $2,186.01 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $7,966.97 | $1,967.84 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $9,969.03 | $2,462.35 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $10,755 | $2,656.47 | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $127,087 | $31,391 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $119,181 | $29,438 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $80,745 | $19,944 | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $12,878 | $3,180.91 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $36,863 | $9,105.09 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $26,702 | $6,595.39 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $69,772 | $17,234 | — | — | — | — |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $139,358 | $34,421 | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $123,541 | $30,515 | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $88,463 | $21,850 | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $99,322 | $24,533 | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $79,712 | $19,689 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $43,584 | $10,765 | — | — | — | — |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 0 | $238,015 | $58,790 | — | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | $132,762 | $32,792 | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $119,555 | $29,530 | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $73,716 | $18,208 | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $43,710 | $10,796 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $51,195 | $12,645 | — | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $124,279 | $30,697 | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $65,121 | $16,085 | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $82,263 | $20,319 | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $45,795 | $11,311 | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $21,009 | $5,189.11 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $56,648 | $14,246 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $35,785 | $8,838.89 | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $16,288 | $4,023.02 | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $15,428 | $3,810.78 | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $56,157 | $13,871 | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $26,994 | $6,667.57 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $31,116 | $7,685.7 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $21,715 | $5,363.57 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $18,618 | $4,598.6 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $21,664 | $5,351.12 | — | — | — | — |