| Psychoses | MS-DRG 885 | $60,300 |
| Psychiatric diagnostic evaluation | CPT 90791 | $656 |
| Psychiatric eval with medical services | CPT 90792 | $957 |
| Psychotherapy 30 minutes | CPT 90832 | $229.68 |
| Psychotherapy 45 minutes | CPT 90834 | $250.1 |
| Psychotherapy 60 minutes | CPT 90837 | $409.22 |
| ED visit level 1 | CPT 99281 | $524.48 |
| ED visit level 2 | CPT 99282 | $1,092.03 |
| ED visit level 3 | CPT 99283 | $1,473.09 |
| ED visit level 4 | CPT 99284 | $5,876 |
| ED visit level 5 | CPT 99285 | $5,795 |
| Critical care, first hour | CPT 99291 | $15,829 |
| CT head without contrast | CPT 70450 | $2,471.67 |
| CT head with contrast | CPT 70460 | $2,583.23 |
| CT head with and without contrast | CPT 70470 | $2,695.14 |
| CT neck with contrast | CPT 70491 | $2,287.87 |
| MRI brain without contrast | CPT 70551 | $1,924.58 |
| MRI brain with contrast | CPT 70552 | $3,234.02 |
| MRI brain with and without contrast | CPT 70553 | $2,959.32 |
| Chest X-ray single view | CPT 71045 | $304.5 |
| Chest X-ray 2 views | CPT 71046 | $480.46 |
| Chest X-ray 3 views | CPT 71047 | $462.44 |
| CT chest without contrast | CPT 71250 | $1,931.56 |
| CT chest with contrast | CPT 71260 | $2,505.88 |
| CT chest with and without contrast | CPT 71270 | $2,515.13 |
| MRI chest without contrast | CPT 71550 | $2,771.3 |
| MRI chest with and without contrast | CPT 71552 | $3,857.5 |
| Lumbosacral spine X-ray | CPT 72100 | $490.24 |
| CT cervical spine without contrast | CPT 72125 | $2,674.21 |
| CT thoracic spine without contrast | CPT 72128 | $1,385.9 |
| CT lumbar spine without contrast | CPT 72131 | $2,010 |
| MRI cervical spine without contrast | CPT 72141 | $3,319.8 |
| MRI thoracic spine without contrast | CPT 72146 | $2,134.5 |
| 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 | $3,423.37 |
| MRI lumbar spine with contrast | CPT 72158 | $4,228.13 |
| CT pelvis without contrast | CPT 72192 | $1,621.3 |
| CT pelvis with contrast | CPT 72193 | $2,002.44 |
| Shoulder X-ray | CPT 73030 | $474.39 |
| Humerus X-ray | CPT 73060 | $355.91 |
| Hand X-ray 3 views | CPT 73130 | $432.56 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,138.86 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,013.8 |
| Knee X-ray 1-2 views | CPT 73560 | $255.03 |
| Ankle X-ray 3 views | CPT 73610 | $476.98 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,936.25 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,957.28 |
| CT abdomen without contrast | CPT 74150 | $1,437.92 |
| CT abdomen with contrast | CPT 74160 | $2,377.97 |
| CT abdomen with and without contrast | CPT 74170 | $2,349.83 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,790.96 |
| CT abdomen and pelvis with contrast | CPT 74177 | $4,247.8 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,145.07 |
| MRI abdomen without contrast | CPT 74181 | $2,027.04 |
| MRI abdomen with and without contrast | CPT 74183 | $2,845.5 |
| Abdominal ultrasound complete | CPT 76700 | $1,287.54 |
| Abdominal ultrasound limited | CPT 76705 | $732.5 |
| Retroperitoneal ultrasound complete | CPT 76770 | $739.13 |
| Obstetric ultrasound first trimester | CPT 76801 | $971.12 |
| Obstetric ultrasound after first trimester | CPT 76805 | $909.15 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $988.26 |
| Transvaginal ultrasound | CPT 76830 | $789.26 |
| Pelvic ultrasound complete | CPT 76856 | $1,066.89 |
| Scrotal ultrasound | CPT 76870 | $884.71 |
| Diagnostic mammography unilateral | CPT 77065 | $375.2 |
| Diagnostic mammography bilateral | CPT 77066 | $385.55 |
| Screening mammography bilateral | CPT 77067 | $358.15 |
| EKG tracing only | CPT 93005 | $561.46 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,840.12 |
| Stress echocardiogram | CPT 93350 | $2,043.67 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $122,908 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $70,510 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $36,286 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $57,248 |
| COPD w MCC | MS-DRG 190 | $60,899 |
| COPD w CC | MS-DRG 191 | $30,185 |
| COPD w/o CC/MCC | MS-DRG 192 | $32,424 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $29,550 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $28,767 |
| AMI discharged alive w MCC | MS-DRG 280 | $79,771 |
| AMI discharged alive w CC | MS-DRG 281 | $45,752 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $36,748 |
| Heart failure & shock w MCC | MS-DRG 291 | $43,954 |
| Heart failure & shock w CC | MS-DRG 292 | $36,630 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $23,799 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $70,805 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $32,296 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $22,149 |
| GI hemorrhage w CC | MS-DRG 378 | $44,788 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $25,641 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $22,153 |
| Fractures of femur w/o MCC | MS-DRG 533 | $127,038 |
| Kidney/UTI w MCC | MS-DRG 689 | $32,805 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $27,261 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $61,398 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $45,544 |
| Basic metabolic panel (BMP) | CPT 80048 | $224.05 |
| Electrolyte panel | CPT 80051 | $94.24 |
| Comprehensive metabolic panel | CPT 80053 | $282.5 |
| Lipid panel | CPT 80061 | $9.52 |
| Renal function panel | CPT 80069 | $114.3 |
| Hepatic function panel | CPT 80076 | $176.8 |
| Urinalysis non-automated | CPT 81002 | $14.5 |
| Urinalysis automated | CPT 81003 | $47.9 |
| Glucose quantitative | CPT 82947 | $47.25 |
| Hemoglobin A1c | CPT 83036 | $55.24 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $19.52 |
| Complete blood count with automated differential | CPT 85025 | $98.5 |
| Complete blood count without differential | CPT 85027 | $107.73 |
| Urine culture bacterial | CPT 87086 | $158.6 |
| Tissue exam by pathologist level IV | CPT 88305 | $228.87 |
| Fetal non-stress test | CPT 59025 | $880.27 |
| Office visit, new patient, 15-29 min | CPT 99202 | $243.99 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $273.89 |
| Office visit, new patient, 45-59 min | CPT 99204 | $415.11 |
| Office visit, new patient, 60-74 min | CPT 99205 | $484.89 |
| Office visit, established patient, 5 min | CPT 99211 | $129.03 |
| Office visit, established patient, 10-19 min | CPT 99212 | $206.4 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $235 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $280 |
| Office visit, established patient, 40-54 min | CPT 99215 | $473.4 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,315.19 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,361.16 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,810.1 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,206.26 |
| Colonoscopy diagnostic | CPT 45378 | $2,158.35 |
| Colonoscopy with biopsy | CPT 45380 | $2,076.38 |
| Colonoscopy with polyp removal | CPT 45385 | $2,966.06 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $259,950 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $137,961 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $76,181 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $82,167 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $63,485 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $219,253 |
| Major joint replacement w MCC | MS-DRG 469 | $187,147 |
| Major joint replacement w/o MCC | MS-DRG 470 | $99,667 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $117,406 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $100,124 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $67,297 |
| OR procedure for obesity w MCC | MS-DRG 619 | $77,426 |
| OR procedure for obesity w CC | MS-DRG 620 | $85,064 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $66,488 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $65,478 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $60,277 |
| PCI single major coronary artery | CPT 92920 | $10,554 |
| PCI with drug-eluting stent | CPT 92928 | $22,842 |
| PCI bypass graft | CPT 92937 | $11,686 |
| Left heart catheterization | CPT 93452 | $12,482 |
| Coronary angiography with cath | CPT 93455 | $12,911 |
| Coronary angiography with bypass cath | CPT 93458 | $14,065 |
