| Psychiatric diagnostic evaluation | CPT 90791 | $194.77 |
| Psychiatric eval with medical services | CPT 90792 | $183.66 |
| Psychotherapy 30 minutes | CPT 90832 | $71.53 |
| Psychotherapy 45 minutes | CPT 90834 | $286.12 |
| Psychotherapy 60 minutes | CPT 90837 | $202.18 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $286.12 |
| ED visit level 1 | CPT 99281 | $99.02 |
| ED visit level 2 | CPT 99282 | $196.06 |
| ED visit level 3 | CPT 99283 | $276.07 |
| ED visit level 4 | CPT 99284 | $527.47 |
| ED visit level 5 | CPT 99285 | $565.63 |
| Critical care, first hour | CPT 99291 | $997.94 |
| CT head without contrast | CPT 70450 | $641.86 |
| CT head with contrast | CPT 70460 | $788.01 |
| CT head with and without contrast | CPT 70470 | $1,108.66 |
| CT neck with contrast | CPT 70491 | $933.61 |
| MRI brain without contrast | CPT 70551 | $919.16 |
| MRI brain with contrast | CPT 70552 | $1,094.22 |
| MRI brain with and without contrast | CPT 70553 | $1,152.56 |
| Chest X-ray single view | CPT 71045 | $62.45 |
| Chest X-ray 2 views | CPT 71046 | $131.16 |
| CT chest without contrast | CPT 71250 | $764.25 |
| CT chest with contrast | CPT 71260 | $930.97 |
| CT chest with and without contrast | CPT 71270 | $1,000.29 |
| MRI chest without contrast | CPT 71550 | $758.56 |
| Lumbosacral spine X-ray | CPT 72100 | $204.51 |
| CT cervical spine without contrast | CPT 72125 | $816.91 |
| CT thoracic spine without contrast | CPT 72128 | $816.91 |
| CT lumbar spine without contrast | CPT 72131 | $875.26 |
| MRI cervical spine without contrast | CPT 72141 | $758.56 |
| MRI thoracic spine without contrast | CPT 72146 | $875.26 |
| MRI lumbar spine without contrast | CPT 72148 | $875.26 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,050.31 |
| MRI cervical spine with and without contrast | CPT 72156 | $991.96 |
| MRI lumbar spine with contrast | CPT 72158 | $1,225.36 |
| CT pelvis without contrast | CPT 72192 | $875.26 |
| CT pelvis with contrast | CPT 72193 | $1,050.31 |
| Shoulder X-ray | CPT 73030 | $160.61 |
| Humerus X-ray | CPT 73060 | $131.16 |
| Hand X-ray 3 views | CPT 73130 | $145.6 |
| MRI upper extremity joint without contrast | CPT 73221 | $875.26 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,050.31 |
| Knee X-ray 1-2 views | CPT 73560 | $81.7 |
| Ankle X-ray 3 views | CPT 73610 | $145.6 |
| MRI lower extremity joint without contrast | CPT 73721 | $933.61 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,108.66 |
| CT abdomen without contrast | CPT 74150 | $802.46 |
| CT abdomen with contrast | CPT 74160 | $1,152.56 |
| CT abdomen with and without contrast | CPT 74170 | $1,225.36 |
| CT abdomen and pelvis without contrast | CPT 74176 | $875.26 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,152.56 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,225.36 |
| MRI abdomen without contrast | CPT 74181 | $875.26 |
| MRI abdomen with and without contrast | CPT 74183 | $991.96 |
| Abdominal ultrasound complete | CPT 76700 | $422.91 |
| Abdominal ultrasound limited | CPT 76705 | $422.91 |
| Retroperitoneal ultrasound complete | CPT 76770 | $350.11 |
| Obstetric ultrasound first trimester | CPT 76801 | $300.1 |
| Obstetric ultrasound after first trimester | CPT 76805 | $316.5 |
| Transvaginal ultrasound | CPT 76830 | $264.1 |
| Pelvic ultrasound complete | CPT 76856 | $408.45 |
| Scrotal ultrasound | CPT 76870 | $306.2 |
| EKG complete | CPT 93000 | $129.65 |
| EKG tracing only | CPT 93005 | $112.6 |
| EKG interpretation only | CPT 93010 | $13.23 |
| Transthoracic echocardiogram complete | CPT 93306 | $875.26 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | — |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | — |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | — |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | — |
| COPD w MCC | MS-DRG 190 | — |
| COPD w CC | MS-DRG 191 | — |
| COPD w/o CC/MCC | MS-DRG 192 | — |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | — |
| AMI discharged alive w MCC | MS-DRG 280 | — |
| AMI discharged alive w CC | MS-DRG 281 | — |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | — |
| Heart failure & shock w MCC | MS-DRG 291 | — |
| Heart failure & shock w CC | MS-DRG 292 | — |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | — |
| Cardiac arrhythmia w MCC | MS-DRG 308 | — |
| Cardiac arrhythmia w CC | MS-DRG 309 | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | — |
| GI hemorrhage w CC | MS-DRG 378 | — |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | — |
| Kidney/UTI w MCC | MS-DRG 689 | — |
| Kidney/UTI w/o MCC | MS-DRG 690 | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | — |
| Basic metabolic panel (BMP) | CPT 80048 | $30.75 |
| General health panel | CPT 80050 | $211.4 |
| Electrolyte panel | CPT 80051 | $25.5 |
| Comprehensive metabolic panel | CPT 80053 | $48.75 |
| Lipid panel | CPT 80061 | $25.83 |
| Renal function panel | CPT 80069 | $30.75 |
| Hepatic function panel | CPT 80076 | $36.38 |
| Urinalysis automated | CPT 81003 | $14.67 |
| Glucose quantitative | CPT 82947 | $16.88 |
| Hemoglobin A1c | CPT 83036 | $30.75 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $31.88 |
| Complete blood count with automated differential | CPT 85025 | $26.63 |
| Complete blood count without differential | CPT 85027 | $26.63 |
| Urine culture bacterial | CPT 87086 | $32.63 |
| Urine culture identification | CPT 87088 | $15.38 |
| Tissue exam by pathologist level IV | CPT 88305 | $65.8 |
| Office visit, new patient, 15-29 min | CPT 99202 | $77.8 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $119.09 |
| Office visit, new patient, 45-59 min | CPT 99204 | $202.71 |
| Office visit, new patient, 60-74 min | CPT 99205 | $261.99 |
| Office visit, established patient, 5 min | CPT 99211 | $55.98 |
| Office visit, established patient, 10-19 min | CPT 99212 | $31.45 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $247.17 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $211.71 |
| Office visit, established patient, 40-54 min | CPT 99215 | $264.63 |
