| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $204 | $163.2 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $271 | $216.8 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $165 | $132 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $202 | $161.6 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $235 | $188 | — | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $411 | $328.8 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $459 | $367.2 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $755 | $604 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,476 | $1,180.8 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,361 | $1,888.8 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,279 | $2,623.2 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | — | — | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,000 | $1,600 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,200 | $1,760 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,400 | $1,920 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,400 | $1,920 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,300 | $1,840 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,900 | $2,320 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,500 | $2,800 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $380 | $304 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $380 | $304 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $380 | $304 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,000 | $1,600 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,500 | $2,000 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,000 | $2,400 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,200 | $2,560 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,000 | $2,400 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,500 | $2,800 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $460 | $368 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,300 | $1,840 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,000 | $1,600 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,000 | $1,600 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,200 | $1,760 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,600 | $2,080 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,600 | $2,080 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,800 | $2,240 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,500 | $2,800 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,300 | $3,440 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,000 | $1,600 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,400 | $1,920 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $380 | $304 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $380 | $304 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $380 | $304 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,400 | $1,920 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,000 | $2,400 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $380 | $304 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $380 | $304 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,200 | $1,760 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,500 | $2,800 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,400 | $1,120 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,900 | $1,520 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,400 | $1,920 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,000 | $3,200 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,500 | $3,600 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,000 | $4,000 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,700 | $2,160 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,100 | $3,280 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $893 | $714.4 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $720 | $576 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $907 | $725.6 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $411 | $328.8 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $514 | $411.2 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,038 | $830.4 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $639 | $511.2 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $771 | $616.8 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $768 | $614.4 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $500 | $400 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $550 | $440 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $500 | $400 | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $77 | $61.6 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $337 | $269.6 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,669 | $2,135.2 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,082 | $865.6 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,000 | $1,600 | — | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | — | — | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | — | — | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | — | — | — | — | — | — |
| 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 | $109 | $87.2 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $276 | $220.8 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $150 | $120 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $131 | $104.8 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $126 | $100.8 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $95 | $76 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $116 | $92.8 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $21 | $16.8 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $43 | $34.4 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $33 | $26.4 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $97 | $77.6 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $156 | $124.8 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $111 | $88.8 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $75 | $60 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $116 | $92.8 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $88 | $70.4 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $370 | $296 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $543 | $434.4 | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | — | — | — | — | — | — |
| 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 |
| Total shoulder arthroplasty | CPT | 23472 | 0 | — | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $37,900 | $30,320 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $37,900 | $30,320 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 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 | — | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $16,700 | $13,360 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $16,700 | $13,360 | — | — | — | — |
| 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 | $16,700 | $13,360 | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | — | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | — | — | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | — | — | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $16,700 | $13,360 | — | — | — | — |
| 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 | $18,729 | $14,983 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $32,748 | $26,198 | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $32,748 | $26,198 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $9,700 | $7,760 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $9,700 | $7,760 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $17,094 | $13,675 | — | — | — | — |