| Psychoses | MS-DRG 885 | $11,251 |
| Psychiatric diagnostic evaluation | CPT 90791 | $156.76 |
| Psychiatric eval with medical services | CPT 90792 | $152.24 |
| Psychotherapy 30 minutes | CPT 90832 | $152.24 |
| Psychotherapy 45 minutes | CPT 90834 | $152.24 |
| Psychotherapy 60 minutes | CPT 90837 | $152.24 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $152.24 |
| ED visit level 1 | CPT 99281 | $179.32 |
| ED visit level 2 | CPT 99282 | $155.25 |
| ED visit level 3 | CPT 99283 | $760.57 |
| ED visit level 4 | CPT 99284 | $418.06 |
| ED visit level 5 | CPT 99285 | $625.09 |
| Critical care, first hour | CPT 99291 | $841.7 |
| CT head without contrast | CPT 70450 | $846.23 |
| CT head with contrast | CPT 70460 | $758.79 |
| CT head with and without contrast | CPT 70470 | $946.61 |
| CT neck with contrast | CPT 70491 | $1,187.54 |
| MRI brain without contrast | CPT 70551 | $2,200.27 |
| MRI brain with contrast | CPT 70552 | $2,381.34 |
| MRI brain with and without contrast | CPT 70553 | $1,133.47 |
| Chest X-ray single view | CPT 71045 | $176.47 |
| Chest X-ray 2 views | CPT 71046 | $271.84 |
| Chest X-ray 3 views | CPT 71047 | $83.02 |
| CT chest without contrast | CPT 71250 | $1,129.5 |
| CT chest with contrast | CPT 71260 | $1,102.51 |
| CT chest with and without contrast | CPT 71270 | $1,102.51 |
| MRI chest without contrast | CPT 71550 | $2,521.08 |
| MRI chest with contrast | CPT 71551 | $1,809.59 |
| MRI chest with and without contrast | CPT 71552 | $2,091.74 |
| Lumbosacral spine X-ray | CPT 72100 | $295.99 |
| CT cervical spine without contrast | CPT 72125 | $1,587.03 |
| CT thoracic spine without contrast | CPT 72128 | $533.87 |
| CT lumbar spine without contrast | CPT 72131 | $1,635.75 |
| MRI cervical spine without contrast | CPT 72141 | $2,418.24 |
| MRI thoracic spine without contrast | CPT 72146 | $2,039.5 |
| MRI lumbar spine without contrast | CPT 72148 | $2,254.06 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,805.25 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,151.78 |
| MRI lumbar spine with contrast | CPT 72158 | $3,293.18 |
| CT pelvis without contrast | CPT 72192 | $1,143.73 |
| CT pelvis with contrast | CPT 72193 | $1,416.56 |
| Shoulder X-ray | CPT 73030 | $86.32 |
| Humerus X-ray | CPT 73060 | $121.6 |
| Hand X-ray 3 views | CPT 73130 | $141.73 |
| MRI upper extremity joint without contrast | CPT 73221 | $870.6 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,080.65 |
| Knee X-ray 1-2 views | CPT 73560 | $86.32 |
| Ankle X-ray 3 views | CPT 73610 | $227.21 |
| MRI lower extremity joint without contrast | CPT 73721 | $916.63 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,959.79 |
| CT abdomen without contrast | CPT 74150 | $1,148.76 |
| CT abdomen with contrast | CPT 74160 | $1,388.95 |
| CT abdomen with and without contrast | CPT 74170 | $676.89 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,367.59 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,221.74 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,010.45 |
| MRI abdomen without contrast | CPT 74181 | $2,558.06 |
| MRI abdomen with and without contrast | CPT 74183 | $3,218.59 |
| Abdominal ultrasound complete | CPT 76700 | $737.51 |
| Abdominal ultrasound limited | CPT 76705 | $853.85 |
| Retroperitoneal ultrasound complete | CPT 76770 | $484.68 |
| Obstetric ultrasound first trimester | CPT 76801 | $436.38 |
| Obstetric ultrasound after first trimester | CPT 76805 | $415.6 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $227.9 |
| Transvaginal ultrasound | CPT 76830 | $821.94 |
| Pelvic ultrasound complete | CPT 76856 | $737.51 |
| Scrotal ultrasound | CPT 76870 | $197.46 |
| Diagnostic mammography unilateral | CPT 77065 | $187.4 |
| Diagnostic mammography bilateral | CPT 77066 | $302 |
| Screening mammography bilateral | CPT 77067 | $249.68 |
| EKG complete | CPT 93000 | $13.25 |
| EKG tracing only | CPT 93005 | $170.69 |
| EKG interpretation only | CPT 93010 | $7.59 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,290.9 |
| Transthoracic echocardiogram | CPT 93307 | $229.03 |
| Stress echocardiogram | CPT 93350 | $519.53 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $22,465 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $10,321 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $6,707.54 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $13,216 |
| COPD w MCC | MS-DRG 190 | $9,291.88 |
| COPD w CC | MS-DRG 191 | $7,679.49 |
| COPD w/o CC/MCC | MS-DRG 192 | $5,873.47 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $6,989.05 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $4,660.04 |
| AMI discharged alive w MCC | MS-DRG 280 | $13,501 |
| AMI discharged alive w CC | MS-DRG 281 | $8,535.22 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $6,836.58 |
| Heart failure & shock w MCC | MS-DRG 291 | $11,394 |
| Heart failure & shock w CC | MS-DRG 292 | $8,836.37 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $4,123.19 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $12,594 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $7,122.94 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $4,992.29 |
| GI hemorrhage w CC | MS-DRG 378 | $8,972.68 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $6,226.77 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $6,249.63 |
| Fractures of femur w/o MCC | MS-DRG 533 | $10,431 |
| Kidney/UTI w MCC | MS-DRG 689 | $9,899.56 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $6,222.24 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $16,292 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $8,088.51 |
| Initial hospital care, low complexity | CPT 99221 | $76.91 |
| Initial hospital care, moderate complexity | CPT 99222 | $121.79 |
| Initial hospital care, high complexity | CPT 99223 | $162.48 |
| Hospital discharge, <30 min | CPT 99238 | $75.81 |
| Hospital discharge, >30 min | CPT 99239 | $107.3 |
| Basic metabolic panel (BMP) | CPT 80048 | $26.2 |
| Electrolyte panel | CPT 80051 | $73.95 |
| Comprehensive metabolic panel | CPT 80053 | $40.93 |
| Lipid panel | CPT 80061 | $16.89 |
| Renal function panel | CPT 80069 | $108.6 |
| Hepatic function panel | CPT 80076 | $25.58 |
| Urinalysis non-automated | CPT 81002 | $27.31 |
| Urinalysis automated | CPT 81003 | $7.94 |
| Glucose quantitative | CPT 82947 | $41.96 |
| Hemoglobin A1c | CPT 83036 | $39.29 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $39.3 |
| Complete blood count with automated differential | CPT 85025 | $24.33 |
| Complete blood count without differential | CPT 85027 | $77.03 |
| Urine culture bacterial | CPT 87086 | $26.45 |
| Urine culture identification | CPT 87088 | $54.44 |
| Tissue exam by pathologist level IV | CPT 88305 | $247.44 |
| Fetal non-stress test | CPT 59025 | $172.34 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $2,206.65 |
| Vaginal delivery only | CPT 59409 | $2,997.76 |
| Vaginal delivery with postpartum | CPT 59410 | $984.6 |
| Routine obstetric care with C-section | CPT 59510 | $2,441.48 |
| C-section delivery only | CPT 59514 | $821.66 |
| C-section with postpartum | CPT 59515 | $1,215.94 |
| Office visit, new patient, 15-29 min | CPT 99202 | $67 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $104.45 |
| Office visit, new patient, 45-59 min | CPT 99204 | $157.01 |
| Office visit, new patient, 60-74 min | CPT 99205 | $207.35 |
| Office visit, established patient, 5 min | CPT 99211 | $21.53 |
| Office visit, established patient, 10-19 min | CPT 99212 | $52.7 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $85.48 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $120.44 |
| Office visit, established patient, 40-54 min | CPT 99215 | $169.25 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,281.63 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,388.18 |
| Sigmoidoscopy diagnostic | CPT 45330 | $929.84 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,263.44 |
| Colonoscopy diagnostic | CPT 45378 | $1,358.89 |
| Colonoscopy with biopsy | CPT 45380 | $1,362.57 |
| Colonoscopy with polyp removal | CPT 45385 | $1,476.43 |
| Total shoulder arthroplasty | CPT 23472 | $17,339 |
| Hip hemiarthroplasty | CPT 27125 | $1,052.39 |
| Total hip replacement | CPT 27130 | $12,131 |
| Total knee replacement | CPT 27447 | $12,131 |
| Knee revision arthroplasty single component | CPT 27486 | $1,303.15 |
| Knee revision arthroplasty all components | CPT 27487 | $1,621.85 |
| Shoulder arthroscopy with decompression | CPT 29826 | $158.81 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $6,735.33 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,059.12 |
| ACL reconstruction | CPT 29888 | $6,735.33 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $39,765 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $18,855 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $13,068 |
| CABG single arterial graft | CPT 33533 | $1,686.47 |
| CABG 2 arterial grafts | CPT 33534 | $1,981.16 |
| CABG 3 arterial grafts | CPT 33535 | $2,201.8 |
| CABG 4+ arterial grafts | CPT 33536 | $2,371.61 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $12,792 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $10,950 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $22,184 |
| Open appendectomy | CPT 44950 | $5,883.03 |
| Laparoscopic appendectomy | CPT 44970 | $5,500.82 |
| Major joint replacement w MCC | MS-DRG 469 | $25,947 |
| Major joint replacement w/o MCC | MS-DRG 470 | $16,539 |
| Laparoscopic cholecystectomy | CPT 47562 | $5,500.82 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $5,500.82 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $22,787 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $16,688 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $12,374 |
| Lap inguinal hernia repair | CPT 49650 | $5,500.82 |
| Total abdominal hysterectomy | CPT 58150 | $945.87 |
| Vaginal hysterectomy | CPT 58260 | $4,654.24 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $5,500.82 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $9,816.02 |
| Lap salpingo-oophorectomy | CPT 58661 | $5,500.82 |
| OR procedure for obesity w MCC | MS-DRG 619 | $19,114 |
| OR procedure for obesity w CC | MS-DRG 620 | $13,656 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $11,770 |
| Complex cataract surgery | CPT 66982 | $2,171.74 |
| Cataract surgery with lens implant | CPT 66984 | $2,171.74 |
| Intravitreal injection | CPT 67028 | $315.84 |
| Vitrectomy mechanical | CPT 67042 | $3,792.88 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $9,077.22 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $13,034 |
| PCI single major coronary artery | CPT 92920 | $5,375.57 |
| PCI with drug-eluting stent | CPT 92928 | $10,692 |
| PCI bypass graft | CPT 92937 | $10,692 |
| Left heart catheterization | CPT 93452 | $3,062.71 |
| Coronary angiography with cath | CPT 93455 | $3,062.71 |
| Coronary angiography with bypass cath | CPT 93458 | $7,507.64 |
