| Psychoses | MS-DRG 885 | $11,404 |
| Psychotherapy 30 minutes | CPT 90832 | — |
| Psychotherapy 45 minutes | CPT 90834 | — |
| Psychotherapy 60 minutes | CPT 90837 | — |
| ED visit level 1 | CPT 99281 | — |
| ED visit level 2 | CPT 99282 | — |
| ED visit level 3 | CPT 99283 | — |
| ED visit level 4 | CPT 99284 | — |
| ED visit level 5 | CPT 99285 | — |
| Critical care, first hour | CPT 99291 | — |
| CT head without contrast | CPT 70450 | — |
| CT head with contrast | CPT 70460 | — |
| CT head with and without contrast | CPT 70470 | — |
| CT neck with contrast | CPT 70491 | — |
| MRI brain without contrast | CPT 70551 | — |
| MRI brain with contrast | CPT 70552 | — |
| MRI brain with and without contrast | CPT 70553 | — |
| Chest X-ray single view | CPT 71045 | — |
| Chest X-ray 2 views | CPT 71046 | — |
| Chest X-ray 3 views | CPT 71047 | — |
| CT chest without contrast | CPT 71250 | — |
| CT chest with contrast | CPT 71260 | — |
| CT chest with and without contrast | CPT 71270 | — |
| MRI chest without contrast | CPT 71550 | — |
| MRI chest with contrast | CPT 71551 | — |
| MRI chest with and without contrast | CPT 71552 | — |
| Lumbosacral spine X-ray | CPT 72100 | — |
| CT cervical spine without contrast | CPT 72125 | — |
| CT thoracic spine without contrast | CPT 72128 | — |
| CT lumbar spine without contrast | CPT 72131 | — |
| MRI cervical spine without contrast | CPT 72141 | — |
| MRI thoracic spine without contrast | CPT 72146 | — |
| MRI lumbar spine without contrast | CPT 72148 | — |
| MRI lumbar spine with and without contrast | CPT 72149 | — |
| MRI cervical spine with and without contrast | CPT 72156 | — |
| MRI lumbar spine with contrast | CPT 72158 | — |
| CT pelvis without contrast | CPT 72192 | — |
| CT pelvis with contrast | CPT 72193 | — |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | — |
| Hand X-ray 3 views | CPT 73130 | — |
| MRI upper extremity joint without contrast | CPT 73221 | — |
| MRI upper extremity joint with and without contrast | CPT 73223 | — |
| Knee X-ray 1-2 views | CPT 73560 | — |
| Ankle X-ray 3 views | CPT 73610 | — |
| MRI lower extremity joint without contrast | CPT 73721 | — |
| MRI lower extremity joint with and without contrast | CPT 73723 | — |
| CT abdomen without contrast | CPT 74150 | — |
| CT abdomen with contrast | CPT 74160 | — |
| CT abdomen with and without contrast | CPT 74170 | — |
| CT abdomen and pelvis without contrast | CPT 74176 | — |
| CT abdomen and pelvis with contrast | CPT 74177 | — |
| CT abdomen and pelvis with and without contrast | CPT 74178 | — |
| MRI abdomen without contrast | CPT 74181 | — |
| MRI abdomen with and without contrast | CPT 74183 | — |
| Abdominal ultrasound complete | CPT 76700 | — |
| Abdominal ultrasound limited | CPT 76705 | — |
| Retroperitoneal ultrasound complete | CPT 76770 | — |
| Obstetric ultrasound first trimester | CPT 76801 | — |
| Obstetric ultrasound after first trimester | CPT 76805 | — |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | — |
| Transvaginal ultrasound | CPT 76830 | — |
| Pelvic ultrasound complete | CPT 76856 | — |
| Scrotal ultrasound | CPT 76870 | — |
| Diagnostic mammography unilateral | CPT 77065 | — |
| Diagnostic mammography bilateral | CPT 77066 | — |
| Screening mammography bilateral | CPT 77067 | — |
| EKG tracing only | CPT 93005 | $3,550.89 |
| Transthoracic echocardiogram complete | CPT 93306 | — |
| Transthoracic echocardiogram | CPT 93307 | — |
| Stress echocardiogram | CPT 93350 | — |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $37,793 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $18,987 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $10,904 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $29,368 |
| COPD w MCC | MS-DRG 190 | $19,604 |
| COPD w CC | MS-DRG 191 | $9,019.77 |
| COPD w/o CC/MCC | MS-DRG 192 | $11,012 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $15,145 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $11,168 |
| AMI discharged alive w MCC | MS-DRG 280 | $1,969.25 |
| AMI discharged alive w CC | MS-DRG 281 | $17,273 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $1,968.06 |
| Heart failure & shock w MCC | MS-DRG 291 | $21,855 |
| Heart failure & shock w CC | MS-DRG 292 | $15,550 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $6,818.58 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $22,627 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $6,965 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $6,965 |
| GI hemorrhage w CC | MS-DRG 378 | $18,430 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $11,847 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $8,312.1 |
| Fractures of femur w/o MCC | MS-DRG 533 | $24,147 |
| Kidney/UTI w MCC | MS-DRG 689 | $22,418 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $14,626 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $21,258 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $19,231 |
| Basic metabolic panel (BMP) | CPT 80048 | — |
| General health panel | CPT 80050 | — |
| Electrolyte panel | CPT 80051 | — |
| Comprehensive metabolic panel | CPT 80053 | — |
| Lipid panel | CPT 80061 | — |
| Renal function panel | CPT 80069 | — |
| Hepatic function panel | CPT 80076 | — |
| Urinalysis non-automated | CPT 81002 | — |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | — |
| Hemoglobin A1c | CPT 83036 | — |
| Thyroid stimulating hormone (TSH) | CPT 84443 | — |
| Complete blood count with automated differential | CPT 85025 | — |
| Complete blood count without differential | CPT 85027 | — |
| Urine culture bacterial | CPT 87086 | — |
| Tissue exam by pathologist level IV | CPT 88305 | — |
| Fetal non-stress test | CPT 59025 | $189.24 |
| Vaginal delivery only | CPT 59409 | — |
| Vaginal delivery w complicating dx | MS-DRG 774 | $7,744.08 |
| Vaginal delivery w/o complicating dx | MS-DRG 775 | $25,083 |
| Office visit, new patient, 15-29 min | CPT 99202 | — |
| Office visit, new patient, 30-44 minutes | CPT 99203 | — |
| Office visit, new patient, 45-59 min | CPT 99204 | — |
| Office visit, new patient, 60-74 min | CPT 99205 | — |
| Office visit, established patient, 5 min | CPT 99211 | — |
| Office visit, established patient, 10-19 min | CPT 99212 | — |
| Office visit, established patient, 20-29 minutes | CPT 99213 | — |
| Office visit, established patient, 30-39 minutes | CPT 99214 | — |
| Office visit, established patient, 40-54 min | CPT 99215 | — |
| Upper GI endoscopy diagnostic | CPT 43235 | — |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,872.48 |
| Sigmoidoscopy diagnostic | CPT 45330 | $885.7 |
| Sigmoidoscopy with biopsy | CPT 45331 | $885.7 |
| Colonoscopy diagnostic | CPT 45378 | $900.93 |
| Colonoscopy with biopsy | CPT 45380 | — |
| Colonoscopy with polyp removal | CPT 45385 | $1,148.09 |
| Shoulder arthroscopy with decompression | CPT 29826 | $6,791.99 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $6,961.79 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $6,791.99 |
| ACL reconstruction | CPT 29888 | $6,961.79 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $86,382 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $45,051 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $31,627 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $31,790 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $25,667 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $2,156.31 |
| Laparoscopic appendectomy | CPT 44970 | $5,757.79 |
| Laparoscopic cholecystectomy | CPT 47562 | $5,856.81 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $5,856.81 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $40,630 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $39,362 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $22,903 |
| Lap inguinal hernia repair | CPT 49650 | $5,757.79 |
| Vaginal hysterectomy | CPT 58260 | $4,846.3 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $5,899.26 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $9,949.78 |
| Lap salpingo-oophorectomy | CPT 58661 | $5,856.81 |
| OR procedure for obesity w CC | MS-DRG 620 | $30,074 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $28,347 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $23,316 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $36,856 |
