| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $621 | $217.35 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,039 | $363.65 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,723 | $603.05 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,774 | $970.9 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,118 | $1,441.3 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,021 | $2,107.35 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $4,876 | $1,706.6 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $7,228 | $2,529.8 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $8,484 | $2,969.4 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $7,228 | $2,529.8 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,047 | $1,416.45 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,871 | $1,704.85 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,188 | $2,165.8 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $670 | $234.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $838 | $293.3 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $1,328 | $464.8 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $4,996 | $1,748.6 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $7,228 | $2,529.8 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $8,484 | $2,969.4 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,362 | $476.7 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $6,188 | $2,165.8 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $664 | $232.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $4,996 | $1,748.6 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $4,996 | $1,748.6 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $4,996 | $1,748.6 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,047 | $1,416.45 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,047 | $1,416.45 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,047 | $1,416.45 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,678 | $1,637.3 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $6,188 | $2,165.8 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $6,188 | $2,165.8 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $4,996 | $1,748.6 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $7,228 | $2,529.8 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $2,656 | $929.6 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $1,328 | $464.8 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,992 | $697.2 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $8,095 | $2,833.25 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,959 | $685.65 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,328 | $464.8 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,992 | $697.2 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $8,095 | $2,833.25 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $12,376 | $4,331.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $4,996 | $1,748.6 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $7,228 | $2,529.8 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $8,484 | $2,969.4 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $9,994 | $3,497.9 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $14,458 | $5,060.3 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $16,967 | $5,938.45 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,047 | $1,416.45 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,188 | $2,165.8 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,289 | $801.15 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $2,289 | $801.15 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $2,289 | $801.15 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,289 | $801.15 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $514 | $179.9 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $3,611 | $1,263.85 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $2,289 | $801.15 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $2,289 | $801.15 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $2,289 | $801.15 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $901 | $315.35 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,088 | $380.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,010 | $353.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $902 | $315.7 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,761 | $1,316.35 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,927 | $1,024.45 | — | — | — |
| 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 | $639 | $223.65 | — | — | — |
| General health panel | CPT | 80050 | 0 | $2,414 | $844.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $458 | $160.3 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $811 | $283.85 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $873 | $305.55 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $463 | $162.05 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $535 | $187.25 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $166 | $58.1 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $121.67 | $42.58 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $255 | $89.25 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $633.39 | $221.69 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $1,097 | $383.95 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $508 | $177.8 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $421 | $147.35 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $527 | $184.45 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $529 | $185.15 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,999 | $699.65 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $593 | $207.55 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $14,569 | $3,496.61 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $19,076 | $4,578.31 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $10,929 | $2,623.02 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $15,233 | $3,655.9 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $12,303 | $2,952.78 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $17,392 | $4,174.17 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $17,571 | $4,217.05 | — | — | — |
| surgery |
| Total hip replacement | CPT | 27130 | 0 | $120,330 | $28,879 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $118,330 | $28,399 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $43,534 | $10,448 | — | — | — |
| 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 | $79,512 | $19,083 | — | — | — |
| 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 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $40,016 | $9,603.93 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $59,560 | $14,294 | — | — | — |
| 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 | $69,342 | $16,642 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $35,940 | $8,625.59 | — | — | — |
| 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 | $17,919 | $4,300.63 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $17,396 | $4,175.13 | — | — | — |
| 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 | $39,326 | $13,764 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $38,543 | $13,490 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $38,543 | $13,490 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $35,387 | $12,385 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $35,387 | $12,385 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $66,793 | $23,378 | — | — | — |