| behavioral |
| Psychoses | MS-DRG | 885 | 0 | $22,335 | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $409 | $245.4 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $229 | $137.4 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $199 | $119.4 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $329 | $197.4 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $474 | $284.4 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $458 | $274.8 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $736 | $441.6 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,698 | $1,018.8 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,373 | $1,423.8 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $10,543 | $6,325.8 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,556 | $2,733.6 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,213 | $1,327.8 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,816 | $1,689.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,442 | $2,065.2 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,064 | $1,838.4 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,522 | $2,713.2 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,812 | $2,887.2 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,798 | $4,078.8 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $368 | $220.8 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $489 | $293.4 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $641 | $384.6 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,767 | $1,660.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,325 | $1,995 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,892 | $2,335.2 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,946 | $2,967.6 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $5,500 | $3,300 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $644 | $386.4 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,785 | $1,671 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,651 | $1,590.6 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,931 | $1,758.6 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,474 | $2,684.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,596 | $2,757.6 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,596 | $2,757.6 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $5,374 | $3,224.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $6,489 | $3,893.4 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $6,014 | $3,608.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,480 | $1,488 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,164 | $1,898.4 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,178 | $706.8 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $502 | $301.2 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,088 | $652.8 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $8,548 | $5,128.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $11,096 | $6,657.6 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,012 | $607.2 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,104 | $662.4 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $8,734 | $5,240.4 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $11,298 | $6,778.8 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,976 | $1,785.6 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,544 | $2,126.4 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $4,173 | $2,503.8 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $5,039 | $3,023.4 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $6,139 | $3,683.4 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $7,160 | $4,296 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,484 | $2,690.4 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,772 | $3,463.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,838 | $1,102.8 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,139 | $683.4 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,322 | $793.2 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $886 | $531.6 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,268 | $760.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,076 | $645.6 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,445 | $867 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,203 | $721.8 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $629 | $377.4 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $746 | $447.6 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $570 | $342 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $323 | $193.8 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,113 | $1,867.8 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $2,256 | $1,353.6 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,877 | $1,726.2 | — | — | — |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 0 | $80,431 | — | — | — | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 0 | $54,681 | — | — | — | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 0 | $41,214 | — | — | — | — |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $54,062 | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $35,132 | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $32,668 | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $16,256 | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $28,365 | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $16,911 | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $64,804 | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | $42,932 | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | $38,288 | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $48,445 | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | $33,247 | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | $33,570 | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | $52,579 | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | $33,479 | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $23,711 | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $35,019 | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $25,742 | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $28,498 | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | $23,257 | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $44,886 | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $31,067 | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $76,512 | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $38,169 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $249 | $149.4 | — | — | — |
| General health panel | CPT | 80050 | 0 | $456 | $273.6 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $190 | $114 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $379 | $227.4 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $286 | $171.6 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $227 | $136.2 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $206 | $123.6 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $44.35 | $26.61 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $43.65 | $26.19 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $60.85 | $36.51 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $163 | $97.8 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $214 | $128.4 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $135 | $81 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $90.6 | $54.36 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $122 | $73.2 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $92.45 | $55.47 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $526 | $315.6 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $454 | $272.4 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,298 | $1,978.8 | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $64.65 | $38.79 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $154 | $92.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $210 | $126 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $271 | $162.6 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $676 | $405.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $3,255 | $1,953 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $8,040 | $4,824 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,432 | $1,459.2 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $3,579 | $2,147.4 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $3,873 | $2,323.8 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $9,480 | $5,688 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $10,198 | $6,118.8 | — | — | — |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $171,769 | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $97,505 | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $62,030 | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $81,421 | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $69,813 | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $163,323 | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $100,374 | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $69,177 | — | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $155,428 | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $112,693 | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $78,724 | — | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | $54,278 | — | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | $84,184 | — | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | $72,996 | — | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $1,384 | $830.4 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $64,844 | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | $77,011 | — | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $14,621 | $8,772.6 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $24,018 | $14,411 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $17,841 | $10,705 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $12,384 | $7,430.4 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $14,393 | $8,635.8 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $18,511 | $11,107 | — | — | — |
