| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $680 | $340 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $409 | $204.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $350 | $175 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $480 | $240 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $699 | $349.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $298 | $149 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $544 | $272 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $958 | $479 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,574 | $787 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,277 | $1,138.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,964 | $1,482 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,204 | $602 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,359 | $1,179.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,471 | $1,235.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,194 | $1,097 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,935 | $1,467.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,085 | $2,042.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,010 | $2,005 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $201 | $100.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $377 | $188.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $287 | $143.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,120 | $560 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,198 | $1,099 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,471 | $1,235.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,762 | $1,381 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,772 | $1,886 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,948 | $1,974 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $407 | $203.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,120 | $560 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,120 | $560 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,120 | $560 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,935 | $1,467.5 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,762 | $1,381 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,762 | $1,381 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,772 | $1,886 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,010 | $2,005 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,772 | $1,886 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,238 | $1,119 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,870 | $935 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $358 | $179 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $358 | $179 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $397 | $198.5 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,762 | $1,381 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,619 | $2,309.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $389 | $194.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $337 | $168.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,692 | $1,346 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,948 | $1,974 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,120 | $560 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,194 | $1,097 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,471 | $1,235.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,698 | $849 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,556 | $1,278 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,831 | $1,415.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,762 | $1,381 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,948 | $1,974 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $902 | $451 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $688 | $344 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $911 | $455.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $662 | $331 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $848 | $424 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $763 | $381.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $763 | $381.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $713 | $356.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $527 | $263.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $656 | $328 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $599 | $299.5 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $381 | $190.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $246 | $123 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $134 | $67 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,441 | $1,220.5 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $2,099 | $1,049.5 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,944 | $1,472 | — | — | — |
| 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 | $518 | $259 | — | — | — |
| 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 | $26 | $13 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $40 | $20 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $46 | $23 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $150 | $75 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $163 | $81.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $99 | $49.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $99 | $49.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $72 | $36 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $92 | $46 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $303 | $151.5 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $597 | $298.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $6,894 | $3,447 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $168 | $84 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $168 | $84 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $168 | $84 | — | — | — |
| preventive |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,693 | $1,346.5 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,712 | $1,356 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,330 | $1,665 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,532 | $1,766 | — | — | — |
| surgery |
| 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 | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $827 | $413.5 | — | — | — |
| 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 | $24,159 | $12,080 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $15,930 | $7,965 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $15,930 | $7,965 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $11,981 | $5,990.5 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $12,412 | $6,206 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $12,100 | $6,050 | — | — | — |