| Psychoses | MS-DRG 885 | $20,988 |
| Psychiatric diagnostic evaluation | CPT 90791 | $470.93 |
| Psychiatric eval with medical services | CPT 90792 | $484.76 |
| Psychotherapy 30 minutes | CPT 90832 | $199.86 |
| Psychotherapy 45 minutes | CPT 90834 | $250.01 |
| Psychotherapy 60 minutes | CPT 90837 | $363.92 |
| ED visit level 1 | CPT 99281 | $53.09 |
| ED visit level 2 | CPT 99282 | $108.4 |
| ED visit level 3 | CPT 99283 | $180.36 |
| ED visit level 4 | CPT 99284 | $316.69 |
| ED visit level 5 | CPT 99285 | $466.93 |
| Critical care, first hour | CPT 99291 | $512.75 |
| Abdominal ultrasound limited | CPT 76705 | $184.49 |
| Obstetric ultrasound first trimester | CPT 76801 | $207.11 |
| Transvaginal ultrasound | CPT 76830 | $150.72 |
| EKG complete | CPT 93000 | $50.23 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $30,028 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $15,300 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $10,504 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $23,430 |
| COPD w MCC | MS-DRG 190 | $16,734 |
| COPD w CC | MS-DRG 191 | $12,838 |
| COPD w/o CC/MCC | MS-DRG 192 | $9,879.76 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $12,292 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $9,681.07 |
| AMI discharged alive w MCC | MS-DRG 280 | $24,039 |
| AMI discharged alive w CC | MS-DRG 281 | $13,958 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $11,073 |
| Heart failure & shock w MCC | MS-DRG 291 | $19,325 |
| Heart failure & shock w CC | MS-DRG 292 | $12,926 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $8,761.24 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $18,151 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $11,259 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $8,762.72 |
| GI hemorrhage w CC | MS-DRG 378 | $14,865 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $9,709.04 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $11,905 |
| Fractures of femur w/o MCC | MS-DRG 533 | $23,504 |
| Kidney/UTI w MCC | MS-DRG 689 | $17,508 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $12,345 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $29,020 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $15,491 |
| Initial hospital care, low complexity | CPT 99221 | $239.35 |
| Initial hospital care, moderate complexity | CPT 99222 | $356.15 |
| Initial hospital care, high complexity | CPT 99223 | $499.05 |
| Hospital discharge, <30 min | CPT 99238 | $213.07 |
| Hospital discharge, >30 min | CPT 99239 | $303.56 |
| Urinalysis non-automated | CPT 81002 | $7.69 |
| Urinalysis automated | CPT 81003 | $4.97 |
| Complete blood count with automated differential | CPT 85025 | $17.17 |
| Office visit, new patient, 15-29 min | CPT 99202 | $217.84 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $321.66 |
| Office visit, new patient, 45-59 min | CPT 99204 | $438.35 |
| Office visit, new patient, 60-74 min | CPT 99205 | $575.73 |
| Office visit, established patient, 5 min | CPT 99211 | $72.18 |
| Office visit, established patient, 10-19 min | CPT 99212 | $153.99 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $243.72 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $340.12 |
| Office visit, established patient, 40-54 min | CPT 99215 | $474.73 |
| Upper GI endoscopy diagnostic | CPT 43235 | $403.2 |
| Total shoulder arthroplasty | CPT 23472 | $2,185.25 |
| Total hip replacement | CPT 27130 | $1,760.11 |
| Total knee replacement | CPT 27447 | $1,821.03 |
| Knee revision arthroplasty single component | CPT 27486 | $1,776.11 |
| Knee revision arthroplasty all components | CPT 27487 | $1,020.59 |
| Shoulder arthroscopy with decompression | CPT 29826 | $496.37 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,246.12 |
| ACL reconstruction | CPT 29888 | $1,233.57 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $68,079 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $35,712 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $25,199 |
| CABG single arterial graft | CPT 33533 | $1,307.14 |
| CABG 2 arterial grafts | CPT 33534 | $2,511.3 |
| CABG 3 arterial grafts | CPT 33535 | $3,355.07 |
| CABG 4+ arterial grafts | CPT 33536 | $3,576.24 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $25,327 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $20,532 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $50,575 |
| Laparoscopic appendectomy | CPT 44970 | $741.16 |
| Major joint replacement w MCC | MS-DRG 469 | $45,072 |
| Major joint replacement w/o MCC | MS-DRG 470 | $28,819 |
| Laparoscopic cholecystectomy | CPT 47562 | $866.89 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $43,292 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $31,257 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $24,435 |
| Lap inguinal hernia repair | CPT 49650 | $499.21 |
| Lap salpingo-oophorectomy | CPT 58661 | $801.43 |
| OR procedure for obesity w MCC | MS-DRG 619 | $42,926 |
| OR procedure for obesity w CC | MS-DRG 620 | $23,983 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $22,631 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $18,691 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $30,588 |
