| Psychiatric diagnostic evaluation | CPT 90791 | $630 |
| Psychiatric eval with medical services | CPT 90792 | $420 |
| Psychotherapy 30 minutes | CPT 90832 | $257.4 |
| Psychotherapy 45 minutes | CPT 90834 | $181.91 |
| Psychotherapy 60 minutes | CPT 90837 | $884.8 |
| ED visit level 1 | CPT 99281 | $699.3 |
| ED visit level 2 | CPT 99282 | $1,005.39 |
| ED visit level 3 | CPT 99283 | $1,543.1 |
| ED visit level 4 | CPT 99284 | $7,072 |
| ED visit level 5 | CPT 99285 | $6,650 |
| Critical care, first hour | CPT 99291 | $14,053 |
| CT head without contrast | CPT 70450 | $3,064.05 |
| CT head with contrast | CPT 70460 | $1,492.53 |
| CT head with and without contrast | CPT 70470 | $2,695.14 |
| CT neck with contrast | CPT 70491 | $2,169.37 |
| MRI brain without contrast | CPT 70551 | $1,924.58 |
| MRI brain with contrast | CPT 70552 | $3,801.75 |
| MRI brain with and without contrast | CPT 70553 | $2,959.32 |
| Chest X-ray single view | CPT 71045 | $243.6 |
| Chest X-ray 2 views | CPT 71046 | $355 |
| Chest X-ray 3 views | CPT 71047 | $460.55 |
| CT chest without contrast | CPT 71250 | $1,639.33 |
| CT chest with contrast | CPT 71260 | $2,505.88 |
| CT chest with and without contrast | CPT 71270 | $2,141.55 |
| MRI chest without contrast | CPT 71550 | $2,771.3 |
| MRI chest with and without contrast | CPT 71552 | $4,286.1 |
| CT cervical spine without contrast | CPT 72125 | $3,065.3 |
| CT thoracic spine without contrast | CPT 72128 | $1,547.7 |
| CT lumbar spine without contrast | CPT 72131 | $1,910.31 |
| MRI cervical spine without contrast | CPT 72141 | $2,503.68 |
| MRI thoracic spine without contrast | CPT 72146 | $2,411.98 |
| MRI lumbar spine without contrast | CPT 72148 | $2,037.88 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,519.85 |
| MRI cervical spine with and without contrast | CPT 72156 | $5,325.76 |
| MRI lumbar spine with contrast | CPT 72158 | $2,767.5 |
| CT pelvis without contrast | CPT 72192 | $1,961.25 |
| CT pelvis with contrast | CPT 72193 | $2,344.32 |
| Shoulder X-ray | CPT 73030 | $442.39 |
| Humerus X-ray | CPT 73060 | $268 |
| Hand X-ray 3 views | CPT 73130 | $427.14 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,177.64 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,841.78 |
| Knee X-ray 1-2 views | CPT 73560 | $211.96 |
| Ankle X-ray 3 views | CPT 73610 | $406.23 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,936.25 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $4,312.7 |
| CT abdomen without contrast | CPT 74150 | $1,272.5 |
| CT abdomen with contrast | CPT 74160 | $2,745.96 |
| CT abdomen with and without contrast | CPT 74170 | $2,828.12 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,074 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,661.9 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,589.82 |
| MRI abdomen without contrast | CPT 74181 | $3,251.71 |
| MRI abdomen with and without contrast | CPT 74183 | $3,002.01 |
| Abdominal ultrasound complete | CPT 76700 | $1,039.36 |
| Abdominal ultrasound limited | CPT 76705 | $879 |
| Retroperitoneal ultrasound complete | CPT 76770 | $736.39 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,044.35 |
| Obstetric ultrasound after first trimester | CPT 76805 | $969 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,084.3 |
| Transvaginal ultrasound | CPT 76830 | $839.33 |
| Pelvic ultrasound complete | CPT 76856 | $1,171.83 |
| Scrotal ultrasound | CPT 76870 | $803.52 |
| Diagnostic mammography unilateral | CPT 77065 | $352.8 |
| Diagnostic mammography bilateral | CPT 77066 | $497.71 |
| Screening mammography bilateral | CPT 77067 | $327.7 |
| EKG tracing only | CPT 93005 | $511.18 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,491.02 |
| Stress echocardiogram | CPT 93350 | $2,124.1 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $61,356 |
| COPD w MCC | MS-DRG 190 | $30,008 |
| COPD w CC | MS-DRG 191 | $42,019 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $36,938 |
| AMI discharged alive w MCC | MS-DRG 280 | $84,286 |
| AMI discharged alive w CC | MS-DRG 281 | $23,292 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $28,292 |
| Heart failure & shock w MCC | MS-DRG 291 | $60,688 |
| Heart failure & shock w CC | MS-DRG 292 | $53,444 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $14,322 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $73,862 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $39,718 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $24,674 |
| GI hemorrhage w CC | MS-DRG 378 | $45,872 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $33,878 |
| Kidney/UTI w MCC | MS-DRG 689 | $44,567 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $31,070 |
| Basic metabolic panel (BMP) | CPT 80048 | $211.2 |
| Electrolyte panel | CPT 80051 | $85.8 |
| Comprehensive metabolic panel | CPT 80053 | $153.68 |
| Lipid panel | CPT 80061 | $9.52 |
| Renal function panel | CPT 80069 | $121.5 |
| Hepatic function panel | CPT 80076 | $162.5 |
| Urinalysis non-automated | CPT 81002 | $19.72 |
| Urinalysis automated | CPT 81003 | $58.31 |
| Glucose quantitative | CPT 82947 | $43.93 |
| Hemoglobin A1c | CPT 83036 | $67.43 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $10.88 |
| Complete blood count with automated differential | CPT 85025 | $137.9 |
| Complete blood count without differential | CPT 85027 | $95 |
| Urine culture bacterial | CPT 87086 | $146.9 |
| Tissue exam by pathologist level IV | CPT 88305 | $219.66 |
| Fetal non-stress test | CPT 59025 | $779 |
| Office visit, new patient, 15-29 min | CPT 99202 | $230 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $285.12 |
| Office visit, new patient, 45-59 min | CPT 99204 | $454.5 |
| Office visit, new patient, 60-74 min | CPT 99205 | $510.63 |
| Office visit, established patient, 5 min | CPT 99211 | $196.37 |
| Office visit, established patient, 10-19 min | CPT 99212 | $258 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $253.8 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $302.4 |
| Office visit, established patient, 40-54 min | CPT 99215 | $468.58 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,535.08 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,763.07 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,651.8 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,171.24 |
| Colonoscopy diagnostic | CPT 45378 | $2,207.41 |
| Colonoscopy with biopsy | CPT 45380 | $1,764 |
| Colonoscopy with polyp removal | CPT 45385 | $375.07 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $231,067 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $144,354 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $87,291 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $193,429 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $125,411 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $103,135 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $81,572 |
| OR procedure for obesity w MCC | MS-DRG 619 | $54,815 |
| OR procedure for obesity w CC | MS-DRG 620 | $104,109 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $67,986 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $80,014 |
| PCI single major coronary artery | CPT 92920 | $11,451 |
| PCI with drug-eluting stent | CPT 92928 | $15,037 |
| PCI bypass graft | CPT 92937 | $12,866 |
| Left heart catheterization | CPT 93452 | $5,313.86 |
| Coronary angiography with cath | CPT 93455 | $16,747 |
| Coronary angiography with bypass cath | CPT 93458 | $13,479 |
