| Psychoses | MS-DRG 885 | $1,266.50 |
| Psychiatric diagnostic evaluation | CPT 90791 | $213.10 |
| Psychiatric eval with medical services | CPT 90792 | $213.10 |
| Psychotherapy 30 minutes | CPT 90832 | — |
| Psychotherapy 45 minutes | CPT 90834 | $148.00 |
| Psychotherapy 60 minutes | CPT 90837 | $175.00 |
| ED visit level 1 | CPT 99281 | $205.09 |
| ED visit level 2 | CPT 99282 | $216.37 |
| ED visit level 3 | CPT 99283 | $294.00 |
| ED visit level 4 | CPT 99284 | $458.00 |
| ED visit level 5 | CPT 99285 | $658.00 |
| Critical care, first hour | CPT 99291 | $1,076.47 |
| CT head without contrast | CPT 70450 | $128.00 |
| CT head with contrast | CPT 70460 | $216.00 |
| CT head with and without contrast | CPT 70470 | $219.17 |
| CT neck with contrast | CPT 70491 | $216.00 |
| MRI brain without contrast | CPT 70551 | $504.03 |
| MRI brain with contrast | CPT 70552 | $505.00 |
| MRI brain with and without contrast | CPT 70553 | $505.00 |
| Chest X-ray single view | CPT 71045 | $104.23 |
| Chest X-ray 2 views | CPT 71046 | $104.23 |
| Chest X-ray 3 views | CPT 71047 | $104.23 |
| CT chest without contrast | CPT 71250 | $141.40 |
| CT chest with contrast | CPT 71260 | $216.00 |
| CT chest with and without contrast | CPT 71270 | $256.54 |
| CT cervical spine without contrast | CPT 72125 | $141.40 |
| CT thoracic spine without contrast | CPT 72128 | $141.40 |
| CT lumbar spine without contrast | CPT 72131 | $141.40 |
| MRI cervical spine without contrast | CPT 72141 | $503.05 |
| MRI thoracic spine without contrast | CPT 72146 | $503.05 |
| MRI lumbar spine without contrast | CPT 72148 | $503.05 |
| MRI cervical spine with and without contrast | CPT 72156 | $505.00 |
| MRI lumbar spine with contrast | CPT 72158 | $505.00 |
| CT pelvis without contrast | CPT 72192 | $141.40 |
| CT pelvis with contrast | CPT 72193 | $216.00 |
| Shoulder X-ray | CPT 73030 | $104.23 |
| Humerus X-ray | CPT 73060 | $104.23 |
| Hand X-ray 3 views | CPT 73130 | $104.23 |
| MRI upper extremity joint without contrast | CPT 73221 | $504.03 |
| Knee X-ray 1-2 views | CPT 73560 | $104.23 |
| Ankle X-ray 3 views | CPT 73610 | $104.23 |
| MRI lower extremity joint without contrast | CPT 73721 | $504.03 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $505.00 |
| CT abdomen without contrast | CPT 74150 | $141.40 |
| CT abdomen with contrast | CPT 74160 | $216.00 |
| CT abdomen with and without contrast | CPT 74170 | $256.54 |
| CT abdomen and pelvis without contrast | CPT 74176 | $128.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $442.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $442.00 |
| MRI abdomen without contrast | CPT 74181 | $504.03 |
| MRI abdomen with and without contrast | CPT 74183 | $505.00 |
| Abdominal ultrasound complete | CPT 76700 | $128.00 |
| Abdominal ultrasound limited | CPT 76705 | $128.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $128.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $128.00 |
| Obstetric ultrasound after first trimester | CPT 76805 | $128.00 |
| Transvaginal ultrasound | CPT 76830 | $128.00 |
| Pelvic ultrasound complete | CPT 76856 | $128.00 |
| Scrotal ultrasound | CPT 76870 | $128.00 |
| Diagnostic mammography unilateral | CPT 77065 | $107.98 |
| Diagnostic mammography bilateral | CPT 77066 | $137.55 |
| Screening mammography bilateral | CPT 77067 | $114.14 |
| EKG tracing only | CPT 93005 | $69.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $604.00 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $24,629 |
| COPD w MCC | MS-DRG 190 | $13,971 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $11,418 |
| Heart failure & shock w MCC | MS-DRG 291 | $16,993 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $14,878 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $9,270.00 |
| Kidney/UTI w MCC | MS-DRG 689 | $14,612 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $10,954 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $23,044 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $13,373 |
| Basic metabolic panel (BMP) | CPT 80048 | $8.46 |
| Electrolyte panel | CPT 80051 | — |
| Comprehensive metabolic panel | CPT 80053 | $10.56 |
| Lipid panel | CPT 80061 | $13.39 |
| Hepatic function panel | CPT 80076 | $8.17 |
| Urinalysis automated | CPT 81003 | $2.25 |
| Glucose quantitative | CPT 82947 | $3.93 |
| Hemoglobin A1c | CPT 83036 | $9.71 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $16.80 |
| Complete blood count with automated differential | CPT 85025 | $7.77 |
| Complete blood count without differential | CPT 85027 | $6.47 |
| Urine culture identification | CPT 87088 | $8.09 |
| Tissue exam by pathologist level IV | CPT 88305 | — |
| Office visit, new patient, 15-29 min | CPT 99202 | $158.65 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $176.81 |
| Office visit, new patient, 45-59 min | CPT 99204 | $146.79 |
| Office visit, new patient, 60-74 min | CPT 99205 | $275.69 |
| Office visit, established patient, 5 min | CPT 99211 | $105.18 |
| Office visit, established patient, 10-19 min | CPT 99212 | $205.84 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $196.89 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $174.12 |
| Office visit, established patient, 40-54 min | CPT 99215 | $313.32 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,451.45 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,546.45 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,004.13 |
| Colonoscopy diagnostic | CPT 45378 | $1,004.13 |
| Colonoscopy with biopsy | CPT 45380 | $1,299.17 |
| Colonoscopy with polyp removal | CPT 45385 | $1,299.17 |
| Shoulder arthroscopy with decompression | CPT 29826 | $3,571.10 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $7,935.57 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,571.10 |
| ACL reconstruction | CPT 29888 | $7,935.57 |
| Major joint replacement w/o MCC | MS-DRG 470 | $22,572 |
| Laparoscopic cholecystectomy | CPT 47562 | $6,253.02 |
| Lap inguinal hernia repair | CPT 49650 | $6,067.36 |
| Cataract surgery with lens implant | CPT 66984 | $2,590.68 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $14,850 |
