| Psychoses | MS-DRG 885 | $10,989 |
| Psychotherapy 30 minutes | CPT 90832 | $224.4 |
| Psychotherapy 45 minutes | CPT 90834 | $286.44 |
| Psychotherapy 60 minutes | CPT 90837 | $353.64 |
| ED visit level 1 | CPT 99281 | $137.7 |
| ED visit level 2 | CPT 99282 | $237.41 |
| ED visit level 3 | CPT 99283 | $396.26 |
| ED visit level 4 | CPT 99284 | $620.86 |
| ED visit level 5 | CPT 99285 | $974.42 |
| Critical care, first hour | CPT 99291 | $1,358.3 |
| CT head without contrast | CPT 70450 | $1,676.64 |
| CT head with contrast | CPT 70460 | $1,974.84 |
| CT head with and without contrast | CPT 70470 | $1,853.04 |
| CT neck with contrast | CPT 70491 | $2,103.36 |
| MRI brain without contrast | CPT 70551 | $2,887.92 |
| MRI brain with contrast | CPT 70552 | $3,074.4 |
| MRI brain with and without contrast | CPT 70553 | $3,144.12 |
| Chest X-ray single view | CPT 71045 | $264.6 |
| Chest X-ray 2 views | CPT 71046 | $332.64 |
| Chest X-ray 3 views | CPT 71047 | $373.8 |
| CT chest without contrast | CPT 71250 | $1,676.64 |
| CT chest with contrast | CPT 71260 | $1,863.12 |
| CT chest with and without contrast | CPT 71270 | $2,414.16 |
| MRI chest without contrast | CPT 71550 | $2,627.52 |
| MRI chest with contrast | CPT 71551 | $2,778.72 |
| MRI chest with and without contrast | CPT 71552 | $3,144.12 |
| Lumbosacral spine X-ray | CPT 72100 | $315.84 |
| CT cervical spine without contrast | CPT 72125 | $1,449 |
| CT thoracic spine without contrast | CPT 72128 | $1,017.24 |
| CT lumbar spine without contrast | CPT 72131 | $1,935.36 |
| MRI cervical spine without contrast | CPT 72141 | $3,074.4 |
| MRI thoracic spine without contrast | CPT 72146 | $3,066.84 |
| MRI lumbar spine without contrast | CPT 72148 | $3,074.4 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,223.92 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,144.12 |
| MRI lumbar spine with contrast | CPT 72158 | $3,144.12 |
| CT pelvis without contrast | CPT 72192 | $1,621.2 |
| CT pelvis with contrast | CPT 72193 | $1,726.2 |
| Shoulder X-ray | CPT 73030 | $297.36 |
| Humerus X-ray | CPT 73060 | $254.52 |
| Hand X-ray 3 views | CPT 73130 | $254.52 |
| MRI upper extremity joint without contrast | CPT 73221 | $3,074.4 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,074.4 |
| Knee X-ray 1-2 views | CPT 73560 | $199.08 |
| Ankle X-ray 3 views | CPT 73610 | $254.52 |
| MRI lower extremity joint without contrast | CPT 73721 | $3,074.4 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,074.4 |
| CT abdomen without contrast | CPT 74150 | $1,588.44 |
| CT abdomen with contrast | CPT 74160 | $1,836.24 |
| CT abdomen with and without contrast | CPT 74170 | $2,205 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,086.16 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,425.52 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,888.36 |
| MRI abdomen without contrast | CPT 74181 | $2,627.52 |
| MRI abdomen with and without contrast | CPT 74183 | $3,074.4 |
| Abdominal ultrasound complete | CPT 76700 | $1,075.2 |
| Abdominal ultrasound limited | CPT 76705 | $792.12 |
| Retroperitoneal ultrasound complete | CPT 76770 | $868.56 |
| Obstetric ultrasound first trimester | CPT 76801 | $657.72 |
| Obstetric ultrasound after first trimester | CPT 76805 | $757.68 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,044.96 |
| Transvaginal ultrasound | CPT 76830 | $758.52 |
| Pelvic ultrasound complete | CPT 76856 | $792.96 |
| Scrotal ultrasound | CPT 76870 | $792.96 |
| Diagnostic mammography unilateral | CPT 77065 | $451.08 |
| Diagnostic mammography bilateral | CPT 77066 | $564.48 |
| Screening mammography bilateral | CPT 77067 | $477.96 |
| EKG tracing only | CPT 93005 | $179.76 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,821.12 |
| Transthoracic echocardiogram | CPT 93307 | $1,225.56 |
| Stress echocardiogram | CPT 93350 | $1,475.04 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $15,443 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $7,971.21 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $5,445.91 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $12,579 |
| COPD w MCC | MS-DRG 190 | $8,786.59 |
| COPD w CC | MS-DRG 191 | $6,758.51 |
| COPD w/o CC/MCC | MS-DRG 192 | $5,130.06 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $6,458.02 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $4,941.76 |
| AMI discharged alive w MCC | MS-DRG 280 | $12,770 |
| AMI discharged alive w CC | MS-DRG 281 | $7,240.36 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $5,728.71 |
| Heart failure & shock w MCC | MS-DRG 291 | $10,184 |
| Heart failure & shock w CC | MS-DRG 292 | $6,774.65 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $4,373.07 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $9,423.68 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $5,837.84 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $4,456.08 |
| GI hemorrhage w CC | MS-DRG 378 | $7,732.97 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $5,049.34 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $6,152.92 |
| Fractures of femur w/o MCC | MS-DRG 533 | $11,875 |
| Kidney/UTI w MCC | MS-DRG 689 | $9,150.08 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $6,324.29 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $15,235 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $8,079.56 |
| Basic metabolic panel (BMP) | CPT 80048 | $67.2 |
| Electrolyte panel | CPT 80051 | $66.36 |
| Comprehensive metabolic panel | CPT 80053 | $97.44 |
| Lipid panel | CPT 80061 | $49.56 |
| Renal function panel | CPT 80069 | $145.32 |
| Hepatic function panel | CPT 80076 | $59.64 |
| Urinalysis non-automated | CPT 81002 | $19.32 |
| Urinalysis automated | CPT 81003 | $52.92 |
| Glucose quantitative | CPT 82947 | $49.88 |
| Hemoglobin A1c | CPT 83036 | $95.76 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $167.16 |
| Complete blood count with automated differential | CPT 85025 | $72.24 |
| Complete blood count without differential | CPT 85027 | $72.24 |
| Urine culture bacterial | CPT 87086 | $70.56 |
| Tissue exam by pathologist level IV | CPT 88305 | $203.82 |
| Fetal non-stress test | CPT 59025 | $438.48 |
| Office visit, established patient, 5 min | CPT 99211 | $108.9 |
| Office visit, established patient, 10-19 min | CPT 99212 | $183.6 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $229.5 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $258 |
| Office visit, established patient, 40-54 min | CPT 99215 | $286.89 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,000.88 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,237.76 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,439.34 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,382.35 |
| Colonoscopy diagnostic | CPT 45378 | $2,185.68 |
| Colonoscopy with biopsy | CPT 45380 | $1,939.56 |
| Colonoscopy with polyp removal | CPT 45385 | $2,019.36 |
| Shoulder arthroscopy with decompression | CPT 29826 | $2,359 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $3,960 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $2,590 |
| ACL reconstruction | CPT 29888 | $2,359 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $35,445 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $18,321 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $12,844 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $12,901 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $10,282 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $27,281 |
| Major joint replacement w MCC | MS-DRG 469 | $25,276 |
| Major joint replacement w/o MCC | MS-DRG 470 | $14,646 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $22,758 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $16,102 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $12,348 |
| Open umbilical hernia repair | CPT 49560 | $2,590 |
| Umbilical hernia repair age 5+ | CPT 49585 | $2,590 |
| Lap inguinal hernia repair | CPT 49650 | $2,590 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $6,525 |
| Lap salpingo-oophorectomy | CPT 58661 | $3,960 |
| OR procedure for obesity w MCC | MS-DRG 619 | $21,110 |
| OR procedure for obesity w CC | MS-DRG 620 | $12,429 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $11,390 |
| Complex cataract surgery | CPT 66982 | $4,725 |
| Cataract surgery with lens implant | CPT 66984 | $4,725 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $9,368.34 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $15,173 |
| PCI single major coronary artery | CPT 92920 | $8,335.47 |
| PCI with drug-eluting stent | CPT 92928 | $10,607 |
| PCI bypass graft | CPT 92937 | $22,985 |
| Left heart catheterization | CPT 93452 | $9,326.54 |
| Coronary angiography with cath | CPT 93455 | $8,765.46 |
| Coronary angiography with bypass cath | CPT 93458 | $8,777.41 |
