| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $776 | $388 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $547 | $273.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $247 | $123.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $486 | $243 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $728 | $364 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $450 | $225 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $399 | $199.5 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $661 | $330.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,085 | $542.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,118 | $1,059 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $5,802 | $2,901 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,238 | $3,119 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,267 | $1,633.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,403 | $1,701.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,267 | $1,633.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,881 | $1,440.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,175 | $1,587.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,786 | $1,893 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $588 | $294 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $317 | $158.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $322 | $161 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,267 | $1,633.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,643 | $1,821.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,292 | $1,646 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,553 | $1,276.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,675 | $2,337.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $421 | $210.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,113 | $1,056.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,856 | $928 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,099 | $1,049.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,099 | $1,049.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,196 | $1,598 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,112 | $2,056 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,192 | $2,096 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,039 | $1,519.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $710 | $355 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $710 | $355 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $382 | $191 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,862 | $931 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,082 | $2,041 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $710 | $355 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $710 | $355 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,869 | $934.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,765 | $1,882.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,267 | $1,633.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,643 | $1,821.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,113 | $1,056.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,039 | $1,519.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,643 | $1,821.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,874 | $937 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,029 | $2,014.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $875 | $437.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $941 | $470.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $941 | $470.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $941 | $470.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $875 | $437.5 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,498 | $749 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $875 | $437.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $941 | $470.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $941 | $470.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $495 | $247.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $654 | $327 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $578 | $289 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,704 | $852 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,475 | $1,737.5 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,112 | $556 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,784 | $1,392 | — | — | — |
| 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 | $78 | $39 | — | — | — |
| General health panel | CPT | 80050 | 0 | $455 | $227.5 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $139 | $69.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $29 | $14.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $62 | $31 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $100 | $50 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $173 | $86.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $170 | $85 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $155 | $77.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $117 | $58.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $137 | $68.5 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $97 | $48.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $5,180 | $2,590 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $698 | $349 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $11,400 | $5,700 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $7,522 | $3,761 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $7,307 | $3,653.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $135 | $67.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $135 | $67.5 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $140 | $70 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $135 | $67.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $260 | $130 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $135 | $67.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $140 | $70 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $145 | $72.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $31,911 | $15,956 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,465 | $1,232.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $7,164 | $3,582 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,192 | $1,096 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,823 | $1,411.5 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $4,944 | $2,472 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,392 | $2,696 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $66,123 | $33,062 | — | — | — |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 0 | — | — | — | — | — |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 0 | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $67,260 | $33,630 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $48,686 | $24,343 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $83,889 | $41,945 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $80,270 | $40,135 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $8,007.5 | $4,003.75 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $44,545 | $22,273 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $11,117 | $5,558.63 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $80,240 | $40,120 | — | — | — |
| 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 | $14,775 | $7,387.5 | — | — | — |
| 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 | $17,188 | $8,594 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $38,816 | $19,408 | — | — | — |
| 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 | $49,673 | $24,837 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $47,419 | $23,710 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $21,713 | $10,857 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $47,041 | $23,521 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $44,700 | $22,350 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $29,272 | $14,636 | — | — | — |
| 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 | $19,903 | $9,951.5 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $16,464 | $8,232 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $14,111 | $7,055.5 | — | — | — |
| Vitrectomy mechanical | CPT | 67042 | 0 | $12,120 | $6,060 | — | — | — |
| 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 | $13,922 | $6,961 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $19,424 | $9,712 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $12,121 | $6,060.5 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $14,929 | $7,464.5 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $12,218 | $6,109 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $28,489 | $14,245 | — | — | — |