| Psychoses | MS-DRG 885 | $10,948 |
| ED visit level 1 | CPT 99281 | $205.9 |
| ED visit level 2 | CPT 99282 | $215.55 |
| ED visit level 3 | CPT 99283 | $290.38 |
| ED visit level 4 | CPT 99284 | $446.57 |
| ED visit level 5 | CPT 99285 | $631.28 |
| Critical care, first hour | CPT 99291 | $867.6 |
| CT head without contrast | CPT 70450 | $817.6 |
| CT head with contrast | CPT 70460 | $912 |
| CT head with and without contrast | CPT 70470 | $1,022 |
| CT neck with contrast | CPT 70491 | $912 |
| MRI brain without contrast | CPT 70551 | $1,472.28 |
| MRI brain with contrast | CPT 70552 | $1,768.25 |
| MRI brain with and without contrast | CPT 70553 | $3,121.32 |
| Chest X-ray single view | CPT 71045 | $90.67 |
| Chest X-ray 2 views | CPT 71046 | $94 |
| Chest X-ray 3 views | CPT 71047 | $145.6 |
| CT chest without contrast | CPT 71250 | $838.32 |
| CT chest with contrast | CPT 71260 | $979.09 |
| CT chest with and without contrast | CPT 71270 | $1,194.26 |
| MRI chest without contrast | CPT 71550 | $1,492.78 |
| MRI chest with and without contrast | CPT 71552 | $2,580.61 |
| Lumbosacral spine X-ray | CPT 72100 | $111.52 |
| CT cervical spine without contrast | CPT 72125 | $912 |
| CT thoracic spine without contrast | CPT 72128 | $912 |
| CT lumbar spine without contrast | CPT 72131 | $912 |
| MRI cervical spine without contrast | CPT 72141 | $1,492.78 |
| MRI thoracic spine without contrast | CPT 72146 | $1,628.25 |
| MRI lumbar spine without contrast | CPT 72148 | $1,607.79 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,768.25 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,153.45 |
| MRI lumbar spine with contrast | CPT 72158 | $3,121.32 |
| CT pelvis without contrast | CPT 72192 | $826.31 |
| CT pelvis with contrast | CPT 72193 | $940.11 |
| Shoulder X-ray | CPT 73030 | $113.84 |
| Humerus X-ray | CPT 73060 | $114.45 |
| Hand X-ray 3 views | CPT 73130 | $112.44 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,168.25 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,696.11 |
| Knee X-ray 1-2 views | CPT 73560 | $112.44 |
| Ankle X-ray 3 views | CPT 73610 | $112.44 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,168.25 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,696.11 |
| CT abdomen without contrast | CPT 74150 | $817.6 |
| CT abdomen with contrast | CPT 74160 | $958.49 |
| CT abdomen with and without contrast | CPT 74170 | $1,159.86 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,185.52 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,322.4 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,481.9 |
| MRI abdomen without contrast | CPT 74181 | $1,492.78 |
| MRI abdomen with and without contrast | CPT 74183 | $2,597.64 |
| Abdominal ultrasound complete | CPT 76700 | $376 |
| Abdominal ultrasound limited | CPT 76705 | $253.13 |
| Retroperitoneal ultrasound complete | CPT 76770 | $426 |
| Obstetric ultrasound first trimester | CPT 76801 | $407.2 |
| Obstetric ultrasound after first trimester | CPT 76805 | $407.2 |
| Transvaginal ultrasound | CPT 76830 | $282.51 |
| Pelvic ultrasound complete | CPT 76856 | $326.8 |
| Scrotal ultrasound | CPT 76870 | $326.8 |
| Diagnostic mammography unilateral | CPT 77065 | $494.1 |
| Diagnostic mammography bilateral | CPT 77066 | $599.98 |
| Screening mammography bilateral | CPT 77067 | $211.53 |
| EKG tracing only | CPT 93005 | $98.4 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,213.6 |
| Transthoracic echocardiogram | CPT 93307 | $683.6 |
| Stress echocardiogram | CPT 93350 | $605.52 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $16,028 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $8,259.62 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $5,729.64 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $12,548 |
| COPD w MCC | MS-DRG 190 | $9,223.57 |
| COPD w CC | MS-DRG 191 | $9,223.57 |
| COPD w/o CC/MCC | MS-DRG 192 | $9,223.57 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $6,672.84 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $5,295.67 |
| AMI discharged alive w MCC | MS-DRG 280 | $9,223.57 |
| AMI discharged alive w CC | MS-DRG 281 | $9,223.57 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $9,223.57 |
| Heart failure & shock w MCC | MS-DRG 291 | $10,383 |
| Heart failure & shock w CC | MS-DRG 292 | $7,007.43 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $4,807.63 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $9,223.57 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $9,223.57 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $9,223.57 |
| GI hemorrhage w CC | MS-DRG 378 | $8,029.83 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $5,310.43 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $6,468.66 |
| Fractures of femur w/o MCC | MS-DRG 533 | $12,587 |
| Kidney/UTI w MCC | MS-DRG 689 | $9,424.06 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $6,700.78 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $15,496 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $8,360.53 |
| Basic metabolic panel (BMP) | CPT 80048 | $57.37 |
| Electrolyte panel | CPT 80051 | $40.38 |
| Comprehensive metabolic panel | CPT 80053 | $84.4 |
| Lipid panel | CPT 80061 | $88.8 |
| Renal function panel | CPT 80069 | $70 |
| Hepatic function panel | CPT 80076 | $132.4 |
| Urinalysis non-automated | CPT 81002 | $15.19 |
| Urinalysis automated | CPT 81003 | $13.74 |
| Glucose quantitative | CPT 82947 | $23.2 |
| Hemoglobin A1c | CPT 83036 | $51.53 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $71.94 |
| Complete blood count with automated differential | CPT 85025 | $59.6 |
| Complete blood count without differential | CPT 85027 | $34 |
| Urine culture bacterial | CPT 87086 | $56.4 |
| Urine culture identification | CPT 87088 | $33.32 |
| Tissue exam by pathologist level IV | CPT 88305 | $112.8 |
| Fetal non-stress test | CPT 59025 | $257.52 |
| Office visit, new patient, 15-29 min | CPT 99202 | $216 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $281.4 |
| Office visit, new patient, 45-59 min | CPT 99204 | $358.8 |
| Office visit, new patient, 60-74 min | CPT 99205 | $526.2 |
| Office visit, established patient, 5 min | CPT 99211 | $129.6 |
| Office visit, established patient, 10-19 min | CPT 99212 | $145.8 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $186.6 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $201.6 |
| Office visit, established patient, 40-54 min | CPT 99215 | $291 |
| Upper GI endoscopy diagnostic | CPT 43235 | — |
| Upper GI endoscopy with biopsy | CPT 43239 | — |
| Sigmoidoscopy diagnostic | CPT 45330 | $868.79 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,414.58 |
| Colonoscopy diagnostic | CPT 45378 | $1,450 |
| Colonoscopy with biopsy | CPT 45380 | — |
| Colonoscopy with polyp removal | CPT 45385 | — |
| Total shoulder arthroplasty | CPT 23472 | $18,004 |
| PCI w drug-eluting stent w MCC | MS-DRG 246 | $9,223.57 |
| PCI w drug-eluting stent w/o MCC | MS-DRG 247 | $9,223.57 |
| Total hip replacement | CPT 27130 | $12,758 |
| Total knee replacement | CPT 27447 | $12,758 |
| Shoulder arthroscopy with decompression | CPT 29826 | $2,275.56 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $6,993.9 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $2,949.36 |
| ACL reconstruction | CPT 29888 | $6,993.9 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $36,099 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $19,026 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $13,481 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $13,549 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $11,019 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $26,866 |
| Laparoscopic appendectomy | CPT 44970 | $5,711.99 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $3,704 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $3,704 |
| Major joint replacement w MCC | MS-DRG 469 | $23,963 |
| Major joint replacement w/o MCC | MS-DRG 470 | $15,391 |
| Laparoscopic cholecystectomy | CPT 47562 | $5,711.99 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $5,711.99 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $23,025 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $16,676 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $13,078 |
| Lap inguinal hernia repair | CPT 49650 | $5,711.99 |
| Vaginal hysterectomy | CPT 58260 | $4,832.91 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $10,193 |
| Lap salpingo-oophorectomy | CPT 58661 | $5,711.99 |
| OR procedure for obesity w MCC | MS-DRG 619 | $22,832 |
| OR procedure for obesity w CC | MS-DRG 620 | $12,840 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $12,126 |
| Complex cataract surgery | CPT 66982 | $2,283.12 |
| Cataract surgery with lens implant | CPT 66984 | $2,261.38 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $10,048 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $16,097 |
| Left heart catheterization | CPT 93452 | $5,363.55 |
| Coronary angiography with bypass cath | CPT 93458 | $7,599.25 |
