| Psychoses | MS-DRG 885 | $10,059 |
| Psychiatric diagnostic evaluation | CPT 90791 | $44.86 |
| Psychiatric eval with medical services | CPT 90792 | $105.95 |
| Psychotherapy 30 minutes | CPT 90832 | $29.34 |
| Psychotherapy 45 minutes | CPT 90834 | $38.83 |
| Psychotherapy 60 minutes | CPT 90837 | $53.49 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $55.39 |
| ED visit level 1 | CPT 99281 | $15.95 |
| ED visit level 2 | CPT 99282 | $51.79 |
| ED visit level 3 | CPT 99283 | $100.33 |
| ED visit level 4 | CPT 99284 | $514.02 |
| ED visit level 5 | CPT 99285 | $665.10 |
| CT head without contrast | CPT 70450 | $412.25 |
| CT head with contrast | CPT 70460 | $451.40 |
| CT head with and without contrast | CPT 70470 | $634.78 |
| CT neck with contrast | CPT 70491 | $585.82 |
| MRI brain without contrast | CPT 70551 | $908.14 |
| MRI brain with and without contrast | CPT 70553 | $1,304.07 |
| Chest X-ray single view | CPT 71045 | $61.43 |
| Chest X-ray 2 views | CPT 71046 | $72.30 |
| CT chest without contrast | CPT 71250 | $507.37 |
| CT chest with contrast | CPT 71260 | $686.46 |
| CT chest with and without contrast | CPT 71270 | $821.61 |
| Lumbosacral spine X-ray | CPT 72100 | $100.08 |
| CT cervical spine without contrast | CPT 72125 | $718.93 |
| CT thoracic spine without contrast | CPT 72128 | $636.65 |
| CT lumbar spine without contrast | CPT 72131 | $591.77 |
| MRI cervical spine without contrast | CPT 72141 | $864.79 |
| MRI thoracic spine without contrast | CPT 72146 | $908.14 |
| MRI lumbar spine without contrast | CPT 72148 | $865.13 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,378.36 |
| MRI lumbar spine with contrast | CPT 72158 | $1,063.86 |
| CT pelvis without contrast | CPT 72192 | $486.60 |
| Shoulder X-ray | CPT 73030 | $71.26 |
| Humerus X-ray | CPT 73060 | $84.55 |
| Hand X-ray 3 views | CPT 73130 | $86.45 |
| MRI upper extremity joint without contrast | CPT 73221 | $908.14 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $908.14 |
| Knee X-ray 1-2 views | CPT 73560 | $68.50 |
| Ankle X-ray 3 views | CPT 73610 | $91.28 |
| MRI lower extremity joint without contrast | CPT 73721 | $912.68 |
| CT abdomen without contrast | CPT 74150 | $438.69 |
| CT abdomen with contrast | CPT 74160 | $541.54 |
| CT abdomen with and without contrast | CPT 74170 | $639.37 |
| CT abdomen and pelvis without contrast | CPT 74176 | $915.45 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,203.43 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,493.28 |
| MRI abdomen without contrast | CPT 74181 | $620.01 |
| MRI abdomen with and without contrast | CPT 74183 | $760.00 |
| Abdominal ultrasound complete | CPT 76700 | $266.77 |
| Abdominal ultrasound limited | CPT 76705 | $165.31 |
| Obstetric ultrasound first trimester | CPT 76801 | $232.77 |
| Pelvic ultrasound complete | CPT 76856 | $264.18 |
| Scrotal ultrasound | CPT 76870 | $260.90 |
| Diagnostic mammography unilateral | CPT 77065 | $135.83 |
| Diagnostic mammography bilateral | CPT 77066 | $160.82 |
| Screening mammography bilateral | CPT 77067 | $8.55 |
| EKG complete | CPT 93000 | $41.24 |
| EKG tracing only | CPT 93005 | — |
| EKG interpretation only | CPT 93010 | $12.24 |
| Transthoracic echocardiogram complete | CPT 93306 | $683.47 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $21,265 |
| COPD w MCC | MS-DRG 190 | $15,074 |
| COPD w CC | MS-DRG 191 | $11,472 |
| 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 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $9,839.94 |
| Heart failure & shock w MCC | MS-DRG 291 | $17,470 |
| Heart failure & shock w CC | MS-DRG 292 | $11,553 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $7,702.13 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $16,384 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $10,011 |
| 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 |
| Initial hospital care, low complexity | CPT 99221 | $72.79 |
| Initial hospital care, moderate complexity | CPT 99222 | $114.33 |
| Initial hospital care, high complexity | CPT 99223 | $152.94 |
| Hospital discharge, <30 min | CPT 99238 | $72.54 |
| Hospital discharge, >30 min | CPT 99239 | $103.34 |
| Basic metabolic panel (BMP) | CPT 80048 | $42.16 |
| General health panel | CPT 80050 | $78.86 |
| Comprehensive metabolic panel | CPT 80053 | $48.96 |
| Lipid panel | CPT 80061 | $32.30 |
| Renal function panel | CPT 80069 | $66.64 |
| Hepatic function panel | CPT 80076 | $57.46 |
| Urinalysis non-automated | CPT 81002 | $8.28 |
| Urinalysis automated | CPT 81003 | $9.69 |
| Glucose quantitative | CPT 82947 | $19.21 |
| Hemoglobin A1c | CPT 83036 | $24.18 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $18.19 |
| Complete blood count with automated differential | CPT 85025 | $23.29 |
| Complete blood count without differential | CPT 85027 | $18.46 |
| Urine culture bacterial | CPT 87086 | $40.55 |
| Office visit, new patient, 15-29 min | CPT 99202 | $13.26 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $50.66 |
| Office visit, new patient, 45-59 min | CPT 99204 | $83.64 |
| Office visit, new patient, 60-74 min | CPT 99205 | $111.52 |
| Office visit, established patient, 5 min | CPT 99211 | $9.84 |
| Office visit, established patient, 10-19 min | CPT 99212 | $36.59 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $38.59 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $56.95 |
| Office visit, established patient, 40-54 min | CPT 99215 | $82.79 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $32,621 |
