| Psychoses | MS-DRG 885 | $71,786 |
| Psychiatric diagnostic evaluation | CPT 90791 | $725 |
| Psychiatric eval with medical services | CPT 90792 | $1,050 |
| ED visit level 1 | CPT 99281 | $564.43 |
| ED visit level 2 | CPT 99282 | $1,083 |
| ED visit level 3 | CPT 99283 | $1,983.56 |
| ED visit level 4 | CPT 99284 | $7,124 |
| ED visit level 5 | CPT 99285 | $6,460 |
| Critical care, first hour | CPT 99291 | $20,710 |
| CT head without contrast | CPT 70450 | $1,764.15 |
| CT head with contrast | CPT 70460 | $2,510.51 |
| CT head with and without contrast | CPT 70470 | $1,524.77 |
| CT neck with contrast | CPT 70491 | $2,315.21 |
| MRI brain without contrast | CPT 70551 | $1,924.58 |
| MRI brain with contrast | CPT 70552 | $3,421.58 |
| MRI brain with and without contrast | CPT 70553 | $2,959.32 |
| Chest X-ray single view | CPT 71045 | $426.3 |
| Chest X-ray 2 views | CPT 71046 | $418.9 |
| Chest X-ray 3 views | CPT 71047 | $426.57 |
| CT chest without contrast | CPT 71250 | $1,938.68 |
| CT chest with contrast | CPT 71260 | $2,694.85 |
| CT chest with and without contrast | CPT 71270 | $3,176.63 |
| MRI chest without contrast | CPT 71550 | $2,612.94 |
| MRI chest with and without contrast | CPT 71552 | $4,133.03 |
| Lumbosacral spine X-ray | CPT 72100 | $507.54 |
| CT cervical spine without contrast | CPT 72125 | $2,843.33 |
| CT thoracic spine without contrast | CPT 72128 | $1,589.91 |
| CT lumbar spine without contrast | CPT 72131 | $1,286.4 |
| MRI cervical spine without contrast | CPT 72141 | $3,734.78 |
| MRI thoracic spine without contrast | CPT 72146 | $1,451.46 |
| MRI lumbar spine without contrast | CPT 72148 | $2,037.88 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,365.37 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,425.08 |
| MRI lumbar spine with contrast | CPT 72158 | $4,243.5 |
| CT pelvis without contrast | CPT 72192 | $1,569 |
| CT pelvis with contrast | CPT 72193 | $2,246.64 |
| Shoulder X-ray | CPT 73030 | $414.15 |
| Humerus X-ray | CPT 73060 | $364.48 |
| Hand X-ray 3 views | CPT 73130 | $461.04 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,300.9 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,837.2 |
| Knee X-ray 1-2 views | CPT 73560 | $314.37 |
| Ankle X-ray 3 views | CPT 73610 | $488.92 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,936.25 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,789.02 |
| CT abdomen without contrast | CPT 74150 | $1,596.99 |
| CT abdomen with contrast | CPT 74160 | $2,615.2 |
| CT abdomen with and without contrast | CPT 74170 | $1,341.28 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,116.69 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,661.9 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,625.4 |
| MRI abdomen without contrast | CPT 74181 | $2,671.05 |
| MRI abdomen with and without contrast | CPT 74183 | $2,390.22 |
| Abdominal ultrasound complete | CPT 76700 | $1,399.5 |
| Abdominal ultrasound limited | CPT 76705 | $328.16 |
| Retroperitoneal ultrasound complete | CPT 76770 | $755.55 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,082.56 |
| Obstetric ultrasound after first trimester | CPT 76805 | $954.75 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $952.64 |
| Transvaginal ultrasound | CPT 76830 | $718.58 |
| Pelvic ultrasound complete | CPT 76856 | $874.5 |
| Scrotal ultrasound | CPT 76870 | $837 |
| Diagnostic mammography unilateral | CPT 77065 | $341.6 |
| Diagnostic mammography bilateral | CPT 77066 | $483.69 |
| Screening mammography bilateral | CPT 77067 | $356.7 |
| EKG tracing only | CPT 93005 | $530.46 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,791.97 |
| Stress echocardiogram | CPT 93350 | $2,224.24 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $77,851 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $76,695 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $50,800 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $79,212 |
| COPD w MCC | MS-DRG 190 | $60,016 |
| COPD w CC | MS-DRG 191 | $37,955 |
| COPD w/o CC/MCC | MS-DRG 192 | $28,714 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $48,327 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $22,375 |
| AMI discharged alive w MCC | MS-DRG 280 | $81,878 |
| AMI discharged alive w CC | MS-DRG 281 | $56,566 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $41,084 |
| Heart failure & shock w MCC | MS-DRG 291 | $67,828 |
| Heart failure & shock w CC | MS-DRG 292 | $40,684 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $26,222 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $34,639 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $36,384 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $25,028 |
| GI hemorrhage w CC | MS-DRG 378 | $49,123 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $25,641 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $30,615 |
| Fractures of femur w/o MCC | MS-DRG 533 | $108,744 |
| Kidney/UTI w MCC | MS-DRG 689 | $27,885 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $36,553 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $95,076 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $37,608 |
| Basic metabolic panel (BMP) | CPT 80048 | $234.08 |
| Electrolyte panel | CPT 80051 | $87.23 |
| Comprehensive metabolic panel | CPT 80053 | $296.51 |
| Lipid panel | CPT 80061 | $9.56 |
| Renal function panel | CPT 80069 | $108 |
| Hepatic function panel | CPT 80076 | $176.8 |
| Urinalysis non-automated | CPT 81002 | $19.65 |
| Urinalysis automated | CPT 81003 | $60.2 |
| Glucose quantitative | CPT 82947 | $46.85 |
| Hemoglobin A1c | CPT 83036 | $53.51 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $22.4 |
| Complete blood count with automated differential | CPT 85025 | $127.06 |
| Complete blood count without differential | CPT 85027 | $104.89 |
| Urine culture bacterial | CPT 87086 | $182 |
| Tissue exam by pathologist level IV | CPT 88305 | $241.5 |
| Fetal non-stress test | CPT 59025 | $880.27 |
| Office visit, new patient, 15-29 min | CPT 99202 | $165.6 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $305.32 |
| Office visit, new patient, 45-59 min | CPT 99204 | $415.11 |
| Office visit, new patient, 60-74 min | CPT 99205 | $551.48 |
| Office visit, established patient, 5 min | CPT 99211 | $201.28 |
| Office visit, established patient, 10-19 min | CPT 99212 | $225.32 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $255.68 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $304.64 |
| Office visit, established patient, 40-54 min | CPT 99215 | $519.4 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,152.59 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,014.25 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,727.51 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,273.5 |
| Colonoscopy diagnostic | CPT 45378 | $2,139.75 |
| Colonoscopy with biopsy | CPT 45380 | $2,499 |
| Colonoscopy with polyp removal | CPT 45385 | $3,021.85 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $258,025 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $138,168 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $92,846 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $79,819 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $65,424 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $180,924 |
| Major joint replacement w MCC | MS-DRG 469 | $195,784 |
| Major joint replacement w/o MCC | MS-DRG 470 | $93,167 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $135,551 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $105,394 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $80,407 |
| OR procedure for obesity w MCC | MS-DRG 619 | $71,944 |
| OR procedure for obesity w CC | MS-DRG 620 | $69,829 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $72,949 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $62,970 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $60,277 |
| PCI single major coronary artery | CPT 92920 | $11,750 |
| PCI with drug-eluting stent | CPT 92928 | $23,271 |
| PCI bypass graft | CPT 92937 | $11,526 |
| Left heart catheterization | CPT 93452 | $12,835 |
| Coronary angiography with cath | CPT 93455 | $15,126 |
| Coronary angiography with bypass cath | CPT 93458 | $7,512.98 |
