| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $601.77 | $541.59 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $456.44 | $410.8 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $259.22 | $233.3 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $343.79 | $309.41 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $507.58 | $456.82 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $483.12 | $434.81 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $544.36 | $489.92 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $841.76 | $757.58 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,684.62 | $1,516.16 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,637.45 | $2,373.71 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,007.86 | $3,607.07 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,457.07 | $5,811.36 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,680.73 | $2,412.66 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,292.89 | $2,963.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,984.44 | $3,586 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,993.01 | $2,693.71 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $5,221.71 | $4,699.54 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $5,416.58 | $4,874.92 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,878.77 | $6,190.89 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $390.56 | $351.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $549.87 | $494.88 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $576.88 | $519.19 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,192.01 | $2,872.81 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,448.35 | $3,103.52 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,784.61 | $3,406.15 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $5,534.82 | $4,981.34 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $8,005.25 | $7,204.73 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $7,352.57 | $6,617.31 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,171.13 | $1,054.02 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,395.73 | $2,156.16 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $3,244.66 | $2,920.19 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,192.57 | $2,873.31 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $5,229.71 | $4,706.74 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $5,376.62 | $4,838.96 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $5,388.47 | $4,849.62 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,900.58 | $5,310.52 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $6,926.73 | $6,234.06 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $7,355.05 | $6,619.55 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,065.78 | $2,759.2 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,517.53 | $3,165.78 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $656.26 | $590.63 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $550.73 | $495.66 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $622.91 | $560.62 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,887.69 | $3,498.92 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,088.04 | $4,579.24 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $725.45 | $652.91 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $683.55 | $615.2 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,523.32 | $3,170.99 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,610.93 | $4,149.84 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,494.5 | $2,245.05 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,166.94 | $2,850.25 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,548.12 | $3,193.31 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $5,661.89 | $5,095.7 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $6,410.49 | $5,769.44 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $7,783.92 | $7,005.53 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,189 | $3,770.1 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,484.11 | $4,935.7 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,195.35 | $1,975.82 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,389.15 | $1,250.24 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,289.1 | $1,160.19 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $694.03 | $624.63 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,355.53 | $1,219.98 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,031.39 | $928.25 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,124.28 | $1,011.85 | — | — | — |
| EKG complete | CPT | 93000 | 0 | — | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $444.03 | $399.63 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $4,574.55 | $4,117.1 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $2,092.79 | $1,883.51 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $235 | $211.5 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $316 | $284.4 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $1,155 | $1,039.5 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $168 | $151.2 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $244 | $219.6 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $479.05 | $431.15 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $169.79 | $152.81 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $405.17 | $364.65 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $195.42 | $175.88 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $278.39 | $250.55 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $293.27 | $263.94 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $91.26 | $82.13 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $61.19 | $55.07 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $77.18 | $69.46 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $124.31 | $111.88 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $218.3 | $196.47 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $154.35 | $138.92 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $138.37 | $124.53 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $145.8 | $131.22 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $385.61 | $347.05 | — | — | — |
| maternity |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | — | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $550.08 | $495.07 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | — | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $161 | $144.9 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $495 | $445.5 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $745 | $670.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $998 | $898.2 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $31 | $27.9 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $102 | $91.8 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $300 | $270 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $450 | $405 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $428 | $385.2 | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | — | — | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | — | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | — | — | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | — | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 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 | — | — | — | — | — |
| 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 | $22,758 | $20,482 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $29,984 | $26,986 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $27,518 | $24,766 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $38,404 | $34,563 | — | — | — |
