| behavioral |
| Psychoses | MS-DRG | 885 | 0 | — | — | — | — | — |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $601.8 | $337.01 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $468.1 | $262.14 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $205.3 | $114.97 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $205.3 | $114.97 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $205.3 | $114.97 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $259.5 | $145.32 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $442.5 | $247.8 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $801.8 | $449.01 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,315.8 | $736.85 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,818.5 | $1,018.36 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,853.6 | $1,598.02 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,258.9 | $1,824.98 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,629.4 | $912.46 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,475 | $1,386 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,300.2 | $1,848.11 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,125.1 | $2,310.06 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $373.2 | $208.99 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $373.2 | $208.99 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $247.4 | $138.54 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,712.5 | $2,079 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,537.6 | $2,541.06 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $5,362.9 | $3,003.22 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $373.2 | $208.99 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,629.4 | $912.46 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,475 | $1,386 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,475 | $1,386 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,475 | $1,386 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,300.2 | $1,848.11 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,125.1 | $2,310.06 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,125.1 | $2,310.06 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $373.2 | $208.99 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $373.2 | $208.99 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $248.8 | $139.33 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,125.1 | $2,310.06 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,775.1 | $3,234.06 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $373.2 | $208.99 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $373.2 | $208.99 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,712.5 | $2,079 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,775.1 | $3,234.06 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,629.4 | $912.46 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,258.9 | $1,824.98 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,444.3 | $1,368.81 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,258.9 | $1,824.98 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,073.7 | $2,281.27 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,950.2 | $2,772.11 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,187.7 | $3,465.11 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,089.9 | $610.34 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $908.3 | $508.65 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $908.3 | $508.65 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $912.1 | $510.78 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,178 | $659.68 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $815.5 | $456.68 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,180.7 | $661.19 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $908.3 | $508.65 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,414.1 | $791.9 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $688.3 | $385.45 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $764.9 | $428.34 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $611.7 | $342.55 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $307.7 | $172.31 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,405.6 | $1,347.14 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,546.7 | $866.15 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $4,897.4 | $2,742.54 | — | — | — |
| 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 | $199.3 | $111.61 | — | — | — |
| General health panel | CPT | 80050 | 0 | $155.1 | $86.86 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $90.2 | $50.51 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $362.8 | $203.17 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $55.2 | $30.91 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $231.2 | $129.47 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $190.9 | $106.9 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $69.3 | $38.81 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $144.4 | $80.86 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $50.9 | $28.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $56.6 | $31.7 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $226.2 | $126.67 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $239.7 | $134.23 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $57.9 | $32.42 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $38.5 | $21.56 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $776.2 | $434.67 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $688.6 | $385.62 | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $139 | $77.84 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $160.8 | $90.05 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $199.4 | $111.66 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $238.3 | $133.45 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $209.8 | $117.49 | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| 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 | — | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
