| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $432 | $216 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $413 | $206.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $218 | $109 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $341 | $170.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $454 | $227 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $494 | $247 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $698 | $349 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,061 | $530.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,364 | $682 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,742 | $871 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,042 | $1,021 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,559 | $779.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,352 | $1,176 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,788 | $1,394 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,517 | $1,258.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,062 | $1,531 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,914 | $1,957 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,389 | $1,694.5 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $828 | $414 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $435 | $217.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $264 | $132 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,470 | $735 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,517 | $1,258.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,788 | $1,394 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,704 | $1,352 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,631 | $1,815.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,609 | $2,304.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $435 | $217.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,701 | $850.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,470 | $735 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,470 | $735 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,160 | $1,580 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,339 | $1,669.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,154 | $1,577 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,886 | $1,943 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,968 | $2,484 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,519 | $2,259.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,470 | $735 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,517 | $1,258.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $828 | $414 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $828 | $414 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $828 | $414 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,840 | $1,420 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,609 | $2,304.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $828 | $414 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $435 | $217.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,840 | $1,420 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,896 | $2,948 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,470 | $735 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,517 | $1,258.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,788 | $1,394 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,834 | $1,417 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,087 | $2,043.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,050 | $2,025 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,840 | $1,420 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,609 | $2,304.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $939 | $469.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $938 | $469 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $936 | $468 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $939 | $469.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $947 | $473.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $939 | $469.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $939 | $469.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $939 | $469.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $382 | $191 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $602 | $301 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $586 | $293 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $299 | $149.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,248 | $624 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,388 | $1,194 | — | — | — |
| 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 | $484 | $242 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $129 | $64.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $24 | $12 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $61 | $30.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $78 | $39 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $135 | $67.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $183 | $91.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $146 | $73 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $92 | $46 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $128 | $64 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $124 | $62 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $415 | $207.5 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $548 | $274 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $7,479 | $3,739.5 | — | — | — |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 0 | — | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $171 | $85.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $228 | $114 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $129 | $64.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $129 | $64.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $129 | $64.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $159 | $79.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $216 | $108 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $129 | $64.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $129 | $64.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,244 | $622 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $3,121 | $1,560.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,177 | $1,088.5 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,693 | $1,346.5 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $4,280 | $2,140 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,348 | $1,174 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $4,142 | $2,071 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $42,084 | $21,042 | — | — | — |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 0 | — | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $33,985 | $16,993 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $46,606 | $23,303 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $17,809 | $8,904.67 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $25,415 | $12,707 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $3,839.5 | $1,919.75 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $11,519 | $5,759.25 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $10,984 | $5,492 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $34,699 | $17,350 | — | — | — |
| 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 | $24,594 | $12,297 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $29,178 | $14,589 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $25,654 | $12,827 | — | — | — |
| 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 | $28,197 | $14,099 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,357.5 | $1,678.75 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $18,394 | $9,197 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $19,914 | $9,957 | — | — | — |
| 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 | $1,282 | $641 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $5,779 | $2,889.5 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $11,017 | $5,508.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $19,412 | $9,706 | — | — | — |
