| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $205 | $102.5 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $190 | $95 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $187 | $93.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $171 | $85.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $330 | $165 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $494 | $247 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $892 | $446 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,343 | $671.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,182 | $1,091 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,867 | $1,933.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,289 | $2,144.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,351 | $675.5 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $236 | $118 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,001 | $1,500.5 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,001 | $1,500.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,601 | $1,800.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $5,514 | $2,757 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,625 | $2,812.5 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $387 | $193.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $387 | $193.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,424 | $712 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,001 | $1,500.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $236 | $118 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,635 | $1,817.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $5,985 | $2,992.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $645 | $322.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,424 | $712 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,413 | $706.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,413 | $706.5 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,601 | $1,800.5 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,635 | $1,817.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,449 | $1,724.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,567 | $2,783.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,928 | $2,964 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,985 | $2,992.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,424 | $712 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $224 | $112 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $388 | $194 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $776 | $388 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $388 | $194 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,635 | $1,817.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $493 | $246.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $418 | $209 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $776 | $388 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,449 | $1,724.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,985 | $2,992.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,424 | $712 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,001 | $1,500.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,001 | $1,500.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,425 | $1,712.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,141 | $2,070.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,364 | $2,182 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,635 | $1,817.5 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,985 | $2,992.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,139 | $569.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,200 | $600 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,200 | $600 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,116 | $558 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,139 | $569.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,139 | $569.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,200 | $600 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,200 | $600 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $464 | $232 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $597 | $298.5 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $494 | $247 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $43 | $21.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $418 | $209 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $19 | $9.5 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,091 | $1,545.5 | — | — | — |
| 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 | $173 | $86.5 | — | — | — |
| General health panel | CPT | 80050 | 0 | $360 | $180 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $61 | $30.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $222 | $111 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $139 | $69.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $89 | $44.5 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $84 | $42 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $25 | $12.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $25 | $12.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $41 | $20.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $103 | $51.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $174 | $87 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $83 | $41.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $70 | $35 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $88 | $44 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $18,240 | $9,120 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $543 | $271.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $126 | $63 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $177 | $88.5 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $310 | $155 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $370 | $185 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $126 | $63 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $126 | $63 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $224 | $112 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $208 | $104 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $815 | $407.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,694 | $1,347 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $3,304 | $1,652 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,694 | $1,347 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $3,914 | $1,957 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $8,184 | $4,092 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $5,866 | $2,933 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,744 | $2,872 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $36,593 | $18,297 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $18,617 | $9,308.67 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $31,776 | $15,888 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $17,601 | $8,800.5 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $7,204.66 | $3,602.33 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $11,572 | $5,786 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $12,690 | $6,345 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $22,568 | $11,284 | — | — | — |
| 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 | $17,681 | $8,840.5 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $12,046 | $6,023 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $13,173 | $6,586.5 | — | — | — |
| 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 | $21,801 | $10,901 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $26,053 | $13,027 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $16,232 | $8,116 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $13,401 | $6,700.5 | — | — | — |
| 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 | — | — | — | — | — |
| 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 | $24,726 | $12,363 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $53,828 | $26,914 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $41,142 | $20,571 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $14,553 | $7,276.5 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $15,645 | $7,822.5 | — | — | — |
