| Psychiatric eval with medical services | CPT 90792 | $57.55 |
| Psychotherapy 60 minutes | CPT 90837 | $66.08 |
| ED visit level 1 | CPT 99281 | $22.15 |
| ED visit level 2 | CPT 99282 | $51.89 |
| ED visit level 3 | CPT 99283 | $100.52 |
| ED visit level 4 | CPT 99284 | $631.55 |
| ED visit level 5 | CPT 99285 | $817.17 |
| CT head without contrast | CPT 70450 | $485.07 |
| CT head with contrast | CPT 70460 | $531.1 |
| CT head with and without contrast | CPT 70470 | $754.23 |
| CT neck with contrast | CPT 70491 | $696.11 |
| MRI brain without contrast | CPT 70551 | $1,133.04 |
| MRI brain with and without contrast | CPT 70553 | $1,627.02 |
| Chest X-ray single view | CPT 71045 | $72.26 |
| Chest X-ray 2 views | CPT 71046 | $85.05 |
| CT chest without contrast | CPT 71250 | $596.85 |
| CT chest with contrast | CPT 71260 | $815.74 |
| CT chest with and without contrast | CPT 71270 | $976.3 |
| Lumbosacral spine X-ray | CPT 72100 | $117.66 |
| CT cervical spine without contrast | CPT 72125 | $854.34 |
| CT thoracic spine without contrast | CPT 72128 | $756.56 |
| CT lumbar spine without contrast | CPT 72131 | $703.11 |
| MRI cervical spine without contrast | CPT 72141 | $1,027.62 |
| MRI thoracic spine without contrast | CPT 72146 | $1,079.16 |
| MRI lumbar spine without contrast | CPT 72148 | $1,028.05 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,637.84 |
| MRI lumbar spine with contrast | CPT 72158 | $1,264.12 |
| CT pelvis without contrast | CPT 72192 | $572.46 |
| Shoulder X-ray | CPT 73030 | $99.05 |
| Humerus X-ray | CPT 73060 | $99.05 |
| Hand X-ray 3 views | CPT 73130 | $101.67 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,079.16 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,079.16 |
| Knee X-ray 1-2 views | CPT 73560 | $80.57 |
| Ankle X-ray 3 views | CPT 73610 | $107.43 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,079.16 |
| CT abdomen without contrast | CPT 74150 | $516.04 |
| CT abdomen with contrast | CPT 74160 | $637.15 |
| CT abdomen with and without contrast | CPT 74170 | $759.74 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,087.86 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,429.98 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,774.43 |
| MRI abdomen without contrast | CPT 74181 | $729.41 |
| MRI abdomen with and without contrast | CPT 74183 | $897.82 |
| Abdominal ultrasound complete | CPT 76700 | $313.76 |
| Abdominal ultrasound limited | CPT 76705 | $194.4 |
| Obstetric ultrasound first trimester | CPT 76801 | $273.9 |
| Pelvic ultrasound complete | CPT 76856 | $310.77 |
| Scrotal ultrasound | CPT 76870 | $306.94 |
| Diagnostic mammography unilateral | CPT 77065 | $191.1 |
| Diagnostic mammography bilateral | CPT 77066 | $191.1 |
| Screening mammography bilateral | CPT 77067 | $10.61 |
| EKG tracing only | CPT 93005 | $84.62 |
| Transthoracic echocardiogram complete | CPT 93306 | $804 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $21,265 |
| COPD w MCC | MS-DRG 190 | $15,074 |
| COPD w/o CC/MCC | MS-DRG 192 | $8,736.34 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $10,967 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $8,552.63 |
| AMI discharged alive w MCC | MS-DRG 280 | $21,829 |
| Heart failure & shock w MCC | MS-DRG 291 | $17,470 |
| Heart failure & shock w CC | MS-DRG 292 | $11,553 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $16,384 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $10,011 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $7,703.49 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $10,609 |
| Kidney/UTI w MCC | MS-DRG 689 | $15,789 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $11,016 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $26,434 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $13,925 |
| Hospital discharge, >30 min | CPT 99239 | $103.34 |
| Basic metabolic panel (BMP) | CPT 80048 | $49.84 |
| Electrolyte panel | CPT 80051 | $41.36 |
| Comprehensive metabolic panel | CPT 80053 | $61.08 |
| Lipid panel | CPT 80061 | $40.3 |
| Renal function panel | CPT 80069 | $83.14 |
| Hepatic function panel | CPT 80076 | $70.98 |
| Urinalysis non-automated | CPT 81002 | $10.23 |
| Urinalysis automated | CPT 81003 | $12.09 |
| Glucose quantitative | CPT 82947 | $2.86 |
| Hemoglobin A1c | CPT 83036 | $28.42 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $64.9 |
| Complete blood count with automated differential | CPT 85025 | $29.06 |
| Complete blood count without differential | CPT 85027 | $22.81 |
| Urine culture bacterial | CPT 87086 | $50.09 |
| Tissue exam by pathologist level IV | CPT 88305 | $39.22 |
| Office visit, established patient, 5 min | CPT 99211 | $146.86 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $20,526 |
