| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $401 | $200.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $401 | $200.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $378 | $189 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $741 | $370.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,379 | $689.5 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,055 | $1,027.5 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,108 | $1,554 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,463 | $2,231.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,404 | $702 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,717 | $858.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,098 | $1,049 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,803 | $901.5 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,759 | $1,379.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,045 | $1,522.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,638 | $2,819 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $446 | $223 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $439 | $219.5 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $390 | $195 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,784 | $892 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,085 | $1,042.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,703 | $1,351.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,328 | $1,164 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,589 | $1,294.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,449 | $2,224.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $419 | $209.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,784 | $892 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,784 | $892 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,784 | $892 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,417 | $1,208.5 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,687 | $1,343.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,687 | $1,343.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,900 | $1,450 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,638 | $2,819 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,376 | $2,688 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,758 | $879 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,939 | $969.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $676 | $338 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $698 | $349 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $659 | $329.5 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,927 | $2,463.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $10,949 | $5,474.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $650 | $325 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $659 | $329.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,189 | $2,094.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $9,376 | $4,688 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,735 | $867.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,043 | $1,021.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,471 | $1,235.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,494 | $1,747 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,044 | $2,022 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,815 | $2,407.5 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,538 | $1,269 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,460 | $2,730 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,286 | $643 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $912 | $456 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,286 | $643 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,421 | $710.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,421 | $710.5 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $817 | $408.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,021 | $510.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,021 | $510.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $984 | $492 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $454 | $227 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $592 | $296 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $907 | $453.5 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $587 | $293.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $960 | $480 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $40 | $20 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,799 | $1,399.5 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $959 | $479.5 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,879 | $939.5 | — | — | — |
| 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 | $78 | $39 | — | — | — |
| General health panel | CPT | 80050 | 0 | $522 | $261 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $179 | $89.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $25 | $12.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $59 | $29.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $76 | $38 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $125 | $62.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $189 | $94.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $99 | $49.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $84 | $42 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $131 | $65.5 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $129 | $64.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $576 | $288 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $521 | $260.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $4,870 | $2,435 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $228 | $114 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $303 | $151.5 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $469 | $234.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $574 | $287 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $271 | $135.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $296 | $148 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $373 | $186.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $565 | $282.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $613 | $306.5 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $7,001.34 | $3,500.67 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $5,514 | $2,757 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $13,220 | $6,610 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $15,636 | $7,818 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $10,424 | $5,212 | — | — | — |
| 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 | — | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $31,954 | $15,977 | — | — | — |
| 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 | $891 | $445.5 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
