| Psychoses | MS-DRG 885 | $15,274 |
| Psychiatric diagnostic evaluation | CPT 90791 | $155.96 |
| Psychiatric eval with medical services | CPT 90792 | $170.73 |
| Psychotherapy 30 minutes | CPT 90832 | $86.33 |
| Psychotherapy 45 minutes | CPT 90834 | $113.28 |
| Psychotherapy 60 minutes | CPT 90837 | $167.63 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $120.94 |
| ED visit level 1 | CPT 99281 | $91.15 |
| ED visit level 2 | CPT 99282 | $163.94 |
| ED visit level 3 | CPT 99283 | $286.64 |
| ED visit level 4 | CPT 99284 | $288.86 |
| ED visit level 5 | CPT 99285 | $634.69 |
| Critical care, first hour | CPT 99291 | $799.56 |
| CT head without contrast | CPT 70450 | $86.87 |
| CT head with contrast | CPT 70460 | $84.63 |
| CT head with and without contrast | CPT 70470 | $94.93 |
| CT neck with contrast | CPT 70491 | $146.25 |
| MRI brain without contrast | CPT 70551 | $184.69 |
| MRI brain with contrast | CPT 70552 | $133.46 |
| MRI brain with and without contrast | CPT 70553 | $291.06 |
| Chest X-ray single view | CPT 71045 | $18.37 |
| Chest X-ray 2 views | CPT 71046 | $34.78 |
| Chest X-ray 3 views | CPT 71047 | $43.51 |
| CT chest without contrast | CPT 71250 | $123.91 |
| CT chest with contrast | CPT 71260 | $144.11 |
| CT chest with and without contrast | CPT 71270 | $184.29 |
| MRI chest without contrast | CPT 71550 | $103.33 |
| MRI chest with contrast | CPT 71551 | $817.88 |
| MRI chest with and without contrast | CPT 71552 | $168.7 |
| Lumbosacral spine X-ray | CPT 72100 | $41.11 |
| CT cervical spine without contrast | CPT 72125 | $108.78 |
| CT thoracic spine without contrast | CPT 72128 | $104.65 |
| CT lumbar spine without contrast | CPT 72131 | $109.48 |
| MRI cervical spine without contrast | CPT 72141 | $101.48 |
| MRI thoracic spine without contrast | CPT 72146 | $110.11 |
| MRI lumbar spine without contrast | CPT 72148 | $163.69 |
| MRI lumbar spine with and without contrast | CPT 72149 | $133.46 |
| MRI cervical spine with and without contrast | CPT 72156 | $251.35 |
| MRI lumbar spine with contrast | CPT 72158 | $234.22 |
| CT pelvis without contrast | CPT 72192 | $119.55 |
| CT pelvis with contrast | CPT 72193 | $86.79 |
| Shoulder X-ray | CPT 73030 | $35.87 |
| Humerus X-ray | CPT 73060 | $33.08 |
| Hand X-ray 3 views | CPT 73130 | $38.7 |
| MRI upper extremity joint without contrast | CPT 73221 | $101.44 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $161.11 |
| Hip X-ray 2 views | CPT 73510 | $37.39 |
| Knee X-ray 1-2 views | CPT 73560 | $35.19 |
| Ankle X-ray 3 views | CPT 73610 | $37.64 |
| MRI lower extremity joint without contrast | CPT 73721 | $101.44 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $160.57 |
| CT abdomen without contrast | CPT 74150 | $88.97 |
| CT abdomen with contrast | CPT 74160 | $94.93 |
| CT abdomen with and without contrast | CPT 74170 | $104.15 |
| CT abdomen and pelvis without contrast | CPT 74176 | $193.12 |
| CT abdomen and pelvis with contrast | CPT 74177 | $201.62 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $149.72 |
| MRI abdomen without contrast | CPT 74181 | $99.94 |
| MRI abdomen with and without contrast | CPT 74183 | $240.43 |
| Abdominal ultrasound complete | CPT 76700 | $119.3 |
| Abdominal ultrasound limited | CPT 76705 | $72.45 |
| Retroperitoneal ultrasound complete | CPT 76770 | $111.29 |
| Obstetric ultrasound first trimester | CPT 76801 | $74.32 |
| Obstetric ultrasound after first trimester | CPT 76805 | $74.87 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $191.1 |
| Transvaginal ultrasound | CPT 76830 | $122.13 |
| Pelvic ultrasound complete | CPT 76856 | $108.43 |
| Scrotal ultrasound | CPT 76870 | $103.2 |
| Diagnostic mammography unilateral | CPT 77065 | $125.8 |
| Diagnostic mammography bilateral | CPT 77066 | $158.9 |
| Screening mammography bilateral | CPT 77067 | $99.34 |
| EKG complete | CPT 93000 | $39.1 |
| EKG tracing only | CPT 93005 | $17.94 |
| EKG interpretation only | CPT 93010 | $23.25 |
| Transthoracic echocardiogram complete | CPT 93306 | $134.95 |
| Transthoracic echocardiogram | CPT 93307 | $142.34 |
| Stress echocardiogram | CPT 93350 | $189.29 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $21,663 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $11,253 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $7,863.08 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $16,999 |
| COPD w MCC | MS-DRG 190 | $12,266 |
| COPD w CC | MS-DRG 191 | $9,512.44 |
| COPD w/o CC/MCC | MS-DRG 192 | $7,421.06 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $9,126.6 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $7,281.14 |
| AMI discharged alive w MCC | MS-DRG 280 | $17,430 |
| AMI discharged alive w CC | MS-DRG 281 | $10,304 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $8,264.82 |
| Heart failure & shock w MCC | MS-DRG 291 | $14,098 |
| Heart failure & shock w CC | MS-DRG 292 | $9,574.98 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $6,631.36 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $13,268 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $8,396.26 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $6,632.42 |
| GI hemorrhage w CC | MS-DRG 378 | $10,945 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $7,301.28 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $8,853.12 |
| Fractures of femur w/o MCC | MS-DRG 533 | $17,051 |
| Kidney/UTI w MCC | MS-DRG 689 | $12,813 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $9,163.7 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $20,950 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $11,388 |
| Initial hospital care, low complexity | CPT 99221 | $270 |
| Initial hospital care, moderate complexity | CPT 99222 | $379.48 |
| Initial hospital care, high complexity | CPT 99223 | $542.63 |
| Hospital discharge, <30 min | CPT 99238 | $234.81 |
| Hospital discharge, >30 min | CPT 99239 | $334.4 |
| Basic metabolic panel (BMP) | CPT 80048 | $16.23 |
| General health panel | CPT 80050 | $56.56 |
| Electrolyte panel | CPT 80051 | $11.2 |
| Comprehensive metabolic panel | CPT 80053 | $22.31 |
| Lipid panel | CPT 80061 | $26.63 |
| Renal function panel | CPT 80069 | $18.51 |
| Hepatic function panel | CPT 80076 | $15.5 |
| Urinalysis non-automated | CPT 81002 | $4.58 |
| Urinalysis automated | CPT 81003 | $4.65 |
| Glucose quantitative | CPT 82947 | $7.97 |
| Hemoglobin A1c | CPT 83036 | $18.8 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $33.32 |
| Complete blood count with automated differential | CPT 85025 | $12.37 |
| Complete blood count without differential | CPT 85027 | $12.16 |
| Urine culture bacterial | CPT 87086 | $17.14 |
| Urine culture identification | CPT 87088 | $17.14 |
| Tissue exam by pathologist level IV | CPT 88305 | $107.48 |
| Fetal non-stress test | CPT 59025 | $79.9 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $6,680.51 |
| Vaginal delivery only | CPT 59409 | $1,953.9 |
| Vaginal delivery with postpartum | CPT 59410 | $2,594.93 |
| Routine obstetric care with C-section | CPT 59510 | $7,340.3 |
| C-section delivery only | CPT 59514 | $1,380.02 |
| C-section with postpartum | CPT 59515 | $3,167.96 |
| Office visit, new patient, 15-29 min | CPT 99202 | $188.96 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $306.32 |
| Office visit, new patient, 45-59 min | CPT 99204 | $466.66 |
| Office visit, new patient, 60-74 min | CPT 99205 | $603.84 |
| Office visit, established patient, 5 min | CPT 99211 | $23.48 |
| Office visit, established patient, 10-19 min | CPT 99212 | $150.51 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $250.27 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $391.5 |
| Office visit, established patient, 40-54 min | CPT 99215 | $502.36 |
| Upper GI endoscopy diagnostic | CPT 43235 | $870.96 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,184.12 |
| Sigmoidoscopy diagnostic | CPT 45330 | $294.38 |
| Sigmoidoscopy with biopsy | CPT 45331 | $208.79 |
| Colonoscopy diagnostic | CPT 45378 | $614.19 |
| Colonoscopy with biopsy | CPT 45380 | $743.71 |
| Colonoscopy with polyp removal | CPT 45385 | $1,194.83 |
| Total shoulder arthroplasty | CPT 23472 | $3,692.65 |
| Hip hemiarthroplasty | CPT 27125 | $2,855.68 |
| Total hip replacement | CPT 27130 | $12,808 |
| Total knee replacement | CPT 27447 | $12,808 |
| Knee revision arthroplasty single component | CPT 27486 | $7,218 |
| Knee revision arthroplasty all components | CPT 27487 | $7,218 |
| Shoulder arthroscopy with decompression | CPT 29826 | $164.18 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,055.15 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,358.86 |
| ACL reconstruction | CPT 29888 | $2,474.24 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $48,559 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $25,681 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $18,250 |
| CABG single arterial graft | CPT 33533 | $2,138 |
| CABG 2 arterial grafts | CPT 33534 | $2,138 |
| CABG 3 arterial grafts | CPT 33535 | $2,272.45 |
| CABG 4+ arterial grafts | CPT 33536 | $2,445.63 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $18,340 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $14,951 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $36,186 |
| Open appendectomy | CPT 44950 | $6,459.45 |
| Laparoscopic appendectomy | CPT 44970 | $1,743.71 |
| Major joint replacement w MCC | MS-DRG 469 | $32,296 |
| Major joint replacement w/o MCC | MS-DRG 470 | $20,809 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,831.22 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $2,073.75 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $31,039 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $22,531 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $17,709 |
| Open umbilical hernia repair | CPT 49560 | $4,169.1 |
| Umbilical hernia repair age 5+ | CPT 49585 | $6,236.36 |
| Lap inguinal hernia repair | CPT 49650 | $756.6 |
| Lap incisional hernia repair | CPT 49652 | $8,994.75 |
| Total abdominal hysterectomy | CPT 58150 | $4,540 |
| Vaginal hysterectomy | CPT 58260 | $2,877.75 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $6,039.79 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $957.57 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,053.64 |
| OR procedure for obesity w MCC | MS-DRG 619 | $30,779 |
| OR procedure for obesity w CC | MS-DRG 620 | $17,390 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $16,434 |
| Complex cataract surgery | CPT 66982 | $749.83 |
| Cataract surgery with lens implant | CPT 66984 | $548.31 |
| Intravitreal injection | CPT 67028 | $298.84 |
| Vitrectomy mechanical | CPT 67042 | $1,144.54 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $13,650 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $22,060 |
| PCI single major coronary artery | CPT 92920 | $481.99 |
| PCI with drug-eluting stent | CPT 92928 | $535.91 |
| PCI bypass graft | CPT 92937 | $535.57 |
| Left heart catheterization | CPT 93452 | $3,334.3 |
| Coronary angiography with cath | CPT 93455 | $3,334.3 |
| Coronary angiography with bypass cath | CPT 93458 | $3,334.3 |
