| 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 | $409 | $204.5 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $805 | $402.5 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,409 | $704.5 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,116 | $1,058 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $5,645 | $2,822.5 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,645 | $2,822.5 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,853 | $926.5 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,589 | $1,294.5 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,843 | $1,421.5 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,589 | $1,294.5 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,584 | $1,792 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,085 | $2,042.5 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,194 | $2,597 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $299 | $149.5 | — | — | — | — |
| 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 | $1,829 | $914.5 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,654 | $1,327 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,063 | $1,531.5 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,982 | $1,991 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,233 | $2,116.5 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,856 | $2,428 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $427 | $213.5 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,178 | $589 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,899 | $949.5 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,120 | $560 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,975 | $1,987.5 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,962 | $1,981 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,579 | $1,789.5 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,194 | $2,597 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,771 | $2,885.5 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $6,019 | $3,009.5 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,238 | $1,119 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,589 | $1,294.5 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $736 | $368 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $736 | $368 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $397 | $198.5 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,205 | $1,602.5 | — | — | — | — |
| 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 | $736 | $368 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $736 | $368 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,528 | $1,764 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,948 | $1,974 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,853 | $926.5 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,633 | $1,316.5 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,897 | $1,448.5 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,253 | $1,626.5 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,757 | $1,878.5 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,073 | $2,536.5 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,982 | $1,991 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,771 | $2,885.5 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $902 | $451 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $820 | $410 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,204 | $602 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $662 | $331 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $885 | $442.5 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $885 | $442.5 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $885 | $442.5 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $885 | $442.5 | — | — | — | — |
| 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 | $980 | $490 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $134 | $67 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,521 | $1,260.5 | — | — | — | — |
| 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 | $36 | $18 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $40 | $20 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $47 | $23.5 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $150 | $75 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $211.55 | $105.78 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $99 | $49.5 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $164 | $82 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $176 | $88 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $190 | $95 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,856 | $928 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $598 | $299 | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $6,894 | $3,447 | — | — | — | — |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 0 | — | — | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $168 | $84 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $126 | $63 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $126 | $63 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $168 | $84 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $252 | $126 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $126 | $63 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $126 | $63 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $126 | $63 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,578 | $1,289 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,693 | $1,346.5 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,978 | $989 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,798 | $899 | — | — | — | — |
| 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 |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $26,149 | $13,075 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $19,970 | $9,985 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $22,005 | $11,003 | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $18,553 | $9,276.5 | — | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $40,286 | $20,143 | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $7,150 | $3,575 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $14,300 | $7,150 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $10,474 | $5,237 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $16,767 | $8,383.34 | — | — | — | — |
| 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 | $13,818 | $6,909 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $27,842 | $13,921 | — | — | — | — |
| 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 | $11,538 | $5,769 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $19,608 | $9,804 | — | — | — | — |
| 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 | $26,782 | $13,391 | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $10,585 | $5,292.34 | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $23,195 | $11,598 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $33,187 | $16,594 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $16,250 | $8,125 | — | — | — | — |
| 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 | — | — | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $11,082 | $5,541 | — | — | — | — |
| 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 | $21,220 | $10,610 | — | — | — | — |
| 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 | $16,902 | $8,451 | — | — | — | — |