| Psychiatric diagnostic evaluation | CPT 90791 | $73 |
| Psychiatric eval with medical services | CPT 90792 | $54 |
| Psychotherapy 30 minutes | CPT 90832 | $34 |
| Psychotherapy 45 minutes | CPT 90834 | $46 |
| Psychotherapy 60 minutes | CPT 90837 | $62 |
| ED visit level 1 | CPT 99281 | $20.4 |
| ED visit level 2 | CPT 99282 | $47.8 |
| ED visit level 3 | CPT 99283 | $92.6 |
| ED visit level 4 | CPT 99284 | $581.8 |
| ED visit level 5 | CPT 99285 | — |
| CT head without contrast | CPT 70450 | $480.2 |
| CT head with contrast | CPT 70460 | $525.8 |
| CT head with and without contrast | CPT 70470 | $746.8 |
| CT neck with contrast | CPT 70491 | $689.2 |
| MRI brain without contrast | CPT 70551 | $1,068.4 |
| MRI brain with and without contrast | CPT 70553 | $1,534.2 |
| Chest X-ray single view | CPT 71045 | $71.2 |
| Chest X-ray 2 views | CPT 71046 | $83.8 |
| CT chest without contrast | CPT 71250 | $591 |
| CT chest with contrast | CPT 71260 | $807.6 |
| CT chest with and without contrast | CPT 71270 | $966.6 |
| Lumbosacral spine X-ray | CPT 72100 | $116 |
| CT cervical spine without contrast | CPT 72125 | $845.8 |
| CT thoracic spine without contrast | CPT 72128 | $749 |
| CT lumbar spine without contrast | CPT 72131 | $696.2 |
| MRI cervical spine without contrast | CPT 72141 | $1,017.4 |
| MRI thoracic spine without contrast | CPT 72146 | $1,003.4 |
| MRI lumbar spine without contrast | CPT 72148 | $1,017.8 |
| MRI lumbar spine with contrast | CPT 72158 | $1,251.6 |
| CT pelvis without contrast | CPT 72192 | $566.8 |
| CT pelvis with contrast | CPT 72193 | $785.8 |
| Shoulder X-ray | CPT 73030 | $82.6 |
| Humerus X-ray | CPT 73060 | $98 |
| Hand X-ray 3 views | CPT 73130 | $100.2 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,068.4 |
| Knee X-ray 1-2 views | CPT 73560 | $79.4 |
| Ankle X-ray 3 views | CPT 73610 | $105.8 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,068.4 |
| CT abdomen without contrast | CPT 74150 | $511 |
| CT abdomen with contrast | CPT 74160 | $630.8 |
| CT abdomen with and without contrast | CPT 74170 | $752.2 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,077 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,415.8 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,756.8 |
| MRI abdomen without contrast | CPT 74181 | $722.2 |
| MRI abdomen with and without contrast | CPT 74183 | $889 |
| Abdominal ultrasound complete | CPT 76700 | $309.2 |
| Abdominal ultrasound limited | CPT 76705 | $191.6 |
| Obstetric ultrasound first trimester | CPT 76801 | $269.8 |
| Transvaginal ultrasound | CPT 76830 | $292.8 |
| Pelvic ultrasound complete | CPT 76856 | $306.2 |
| Scrotal ultrasound | CPT 76870 | $302.4 |
| Diagnostic mammography unilateral | CPT 77065 | $189.2 |
| Diagnostic mammography bilateral | CPT 77066 | $189.2 |
| Screening mammography bilateral | CPT 77067 | $10 |
| EKG tracing only | CPT 93005 | $79.4 |
| Transthoracic echocardiogram complete | CPT 93306 | $792.2 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $21,376 |
| COPD w MCC | MS-DRG 190 | $15,152 |
| COPD w CC | MS-DRG 191 | $11,531 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $11,024 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $8,597.23 |
| Heart failure & shock w MCC | MS-DRG 291 | $17,561 |
| Heart failure & shock w CC | MS-DRG 292 | $11,613 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $7,742.3 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $16,469 |
| Kidney/UTI w MCC | MS-DRG 689 | $15,872 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $11,073 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $26,571 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $13,998 |
| Hospital discharge, >30 min | CPT 99239 | $103.34 |
| Basic metabolic panel (BMP) | CPT 80048 | $49.6 |
| Comprehensive metabolic panel | CPT 80053 | $57.6 |
| Lipid panel | CPT 80061 | $38 |
| Renal function panel | CPT 80069 | $78.4 |
| Hepatic function panel | CPT 80076 | $66.6 |
| Urinalysis non-automated | CPT 81002 | $9.6 |
| Urinalysis automated | CPT 81003 | $11.4 |
| Glucose quantitative | CPT 82947 | $22.6 |
| Hemoglobin A1c | CPT 83036 | $26.8 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $21.4 |
| Complete blood count with automated differential | CPT 85025 | $27.4 |
| Complete blood count without differential | CPT 85027 | $21.4 |
| Urine culture bacterial | CPT 87086 | $47 |
| Tissue exam by pathologist level IV | CPT 88305 | $36.8 |
| Vaginal delivery only | CPT 59409 | $1,128.2 |
| Office visit, established patient, 5 min | CPT 99211 | $137.8 |
