| Psychoses | MS-DRG 885 | $16,538 |
| Psychiatric diagnostic evaluation | CPT 90791 | $177.84 |
| Psychotherapy 30 minutes | CPT 90832 | $117.38 |
| Psychotherapy 45 minutes | CPT 90834 | $117.38 |
| Psychotherapy 60 minutes | CPT 90837 | $117.92 |
| ED visit level 1 | CPT 99281 | $76.00 |
| ED visit level 2 | CPT 99282 | $139.40 |
| ED visit level 3 | CPT 99283 | $173.67 |
| ED visit level 4 | CPT 99284 | $302.60 |
| ED visit level 5 | CPT 99285 | $270.66 |
| Critical care, first hour | CPT 99291 | $322.14 |
| CT head without contrast | CPT 70450 | $1,777.51 |
| CT head with contrast | CPT 70460 | $2,629.96 |
| CT head with and without contrast | CPT 70470 | $2,998.96 |
| CT neck with contrast | CPT 70491 | $2,784.75 |
| MRI brain without contrast | CPT 70551 | $2,660.03 |
| MRI brain with contrast | CPT 70552 | $3,227.84 |
| MRI brain with and without contrast | CPT 70553 | $4,218.20 |
| Chest X-ray single view | CPT 71045 | $194.40 |
| Chest X-ray 2 views | CPT 71046 | $643.37 |
| Chest X-ray 3 views | CPT 71047 | $553.13 |
| CT chest without contrast | CPT 71250 | $2,489.10 |
| CT chest with contrast | CPT 71260 | $2,954.94 |
| CT chest with and without contrast | CPT 71270 | $3,496.34 |
| MRI chest without contrast | CPT 71550 | $2,787.68 |
| MRI chest with contrast | CPT 71551 | $3,383.36 |
| MRI chest with and without contrast | CPT 71552 | $4,420.67 |
| Lumbosacral spine X-ray | CPT 72100 | $462.17 |
| CT cervical spine without contrast | CPT 72125 | $2,338.72 |
| CT thoracic spine without contrast | CPT 72128 | $2,299.84 |
| CT lumbar spine without contrast | CPT 72131 | $2,274.89 |
| MRI cervical spine without contrast | CPT 72141 | $2,688.64 |
| MRI thoracic spine without contrast | CPT 72146 | $2,787.68 |
| MRI lumbar spine without contrast | CPT 72148 | $2,787.68 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,383.36 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,289.36 |
| MRI lumbar spine with contrast | CPT 72158 | $4,447.82 |
| CT pelvis without contrast | CPT 72192 | $1,456.93 |
| CT pelvis with contrast | CPT 72193 | $2,109.10 |
| Shoulder X-ray | CPT 73030 | $352.87 |
| Humerus X-ray | CPT 73060 | $650.81 |
| Hand X-ray 3 views | CPT 73130 | $338.43 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,885.65 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,603.71 |
| Knee X-ray 1-2 views | CPT 73560 | $698.49 |
| Ankle X-ray 3 views | CPT 73610 | $352.87 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,885.65 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $4,603.71 |
| CT abdomen without contrast | CPT 74150 | $2,412.08 |
| CT abdomen with contrast | CPT 74160 | $3,074.52 |
| CT abdomen with and without contrast | CPT 74170 | $3,855.07 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,681.94 |
| CT abdomen and pelvis with contrast | CPT 74177 | $4,938.60 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $6,347.11 |
| MRI abdomen without contrast | CPT 74181 | $2,329.64 |
| MRI abdomen with and without contrast | CPT 74183 | $4,447.82 |
| Abdominal ultrasound complete | CPT 76700 | $1,016.77 |
| Abdominal ultrasound limited | CPT 76705 | $639.96 |
| Retroperitoneal ultrasound complete | CPT 76770 | $812.83 |
| Obstetric ultrasound first trimester | CPT 76801 | $765.88 |
| Obstetric ultrasound after first trimester | CPT 76805 | $765.88 |
| Transvaginal ultrasound | CPT 76830 | $752.67 |
| Pelvic ultrasound complete | CPT 76856 | $812.10 |
| Scrotal ultrasound | CPT 76870 | $716.73 |
| Diagnostic mammography unilateral | CPT 77065 | $351.39 |
| Diagnostic mammography bilateral | CPT 77066 | $535.53 |
| Screening mammography bilateral | CPT 77067 | $251.74 |
| EKG tracing only | CPT 93005 | $147.42 |
| EKG interpretation only | CPT 93010 | $52.09 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,098.90 |
| Transthoracic echocardiogram | CPT 93307 | $941.21 |
| Stress echocardiogram | CPT 93350 | $968.35 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $30,858 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $16,997 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $12,383 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $23,879 |
| COPD w MCC | MS-DRG 190 | $16,513 |
| COPD w CC | MS-DRG 191 | $13,553 |
| COPD w/o CC/MCC | MS-DRG 192 | $10,369 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $12,907 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $9,869.95 |
| AMI discharged alive w MCC | MS-DRG 280 | $24,347 |
| AMI discharged alive w CC | MS-DRG 281 | $15,022 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $12,647 |
| Heart failure & shock w MCC | MS-DRG 291 | $19,149 |
| Heart failure & shock w CC | MS-DRG 292 | $12,863 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $9,739.56 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $17,865 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $11,081 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $8,594.74 |
| GI hemorrhage w CC | MS-DRG 378 | $15,767 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $10,536 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $11,680 |
| Fractures of femur w/o MCC | MS-DRG 533 | $27,888 |
| Kidney/UTI w MCC | MS-DRG 689 | $18,655 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $11,682 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $30,319 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $15,720 |
| Basic metabolic panel (BMP) | CPT 80048 | $206.88 |
| Electrolyte panel | CPT 80051 | $145.25 |
| Comprehensive metabolic panel | CPT 80053 | $239.15 |
| Lipid panel | CPT 80061 | $211.28 |
| Renal function panel | CPT 80069 | $173.13 |
| Hepatic function panel | CPT 80076 | $215.17 |
| Urinalysis non-automated | CPT 81002 | $47.26 |
| Urinalysis automated | CPT 81003 | $35.03 |
| Glucose quantitative | CPT 82947 | $48.37 |
| Hemoglobin A1c | CPT 83036 | $153.46 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $210.17 |
| Complete blood count with automated differential | CPT 85025 | $105.64 |
| Complete blood count without differential | CPT 85027 | $89.50 |
| Urine culture bacterial | CPT 87086 | $202.38 |
| Urine culture identification | CPT 87088 | $85.10 |
| Tissue exam by pathologist level IV | CPT 88305 | $231.85 |
| Fetal non-stress test | CPT 59025 | $413.75 |
| Vaginal delivery only | CPT 59409 | $1,194.18 |
| Office visit, new patient, 15-29 min | CPT 99202 | $115.44 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $163.59 |
| Office visit, new patient, 45-59 min | CPT 99204 | $275.10 |
| Office visit, new patient, 60-74 min | CPT 99205 | $358.73 |
| Office visit, established patient, 5 min | CPT 99211 | $23.40 |
| Office visit, established patient, 10-19 min | CPT 99212 | $56.94 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $112.87 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $167.99 |
| Office visit, established patient, 40-54 min | CPT 99215 | $236.95 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,910.09 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,910.09 |
| Sigmoidoscopy diagnostic | CPT 45330 | $701.49 |
| Sigmoidoscopy with biopsy | CPT 45331 | $3,500.01 |
| Colonoscopy diagnostic | CPT 45378 | $1,758.75 |
| Colonoscopy with biopsy | CPT 45380 | $407.48 |
| Colonoscopy with polyp removal | CPT 45385 | $3,607.11 |
| Total shoulder arthroplasty | CPT 23472 | $2,645.32 |
| Total hip replacement | CPT 27130 | $18,453 |
| Total knee replacement | CPT 27447 | $3,362.62 |
| Knee revision arthroplasty single component | CPT 27486 | $3,021.04 |
| Shoulder arthroscopy with decompression | CPT 29826 | $1,417.42 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,473.13 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $606.00 |
| ACL reconstruction | CPT 29888 | $2,058.66 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $66,855 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $37,872 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $27,057 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $27,019 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $21,959 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $60,811 |
| Laparoscopic appendectomy | CPT 44970 | $1,030.55 |
| Major joint replacement w MCC | MS-DRG 469 | $47,698 |
| Major joint replacement w/o MCC | MS-DRG 470 | $28,027 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,203.84 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $1,257.40 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $49,058 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $34,853 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $26,222 |
| Lap inguinal hernia repair | CPT 49650 | $906.44 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,179.28 |
| OR procedure for obesity w MCC | MS-DRG 619 | $46,230 |
| OR procedure for obesity w CC | MS-DRG 620 | $25,783 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $22,899 |
| Complex cataract surgery | CPT 66982 | $1,922.34 |
| Cataract surgery with lens implant | CPT 66984 | $671.82 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $19,114 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $26,844 |
