| Psychotherapy 60 minutes | CPT 90837 | $6,236 |
| ED visit level 1 | CPT 99281 | $5,377 |
| ED visit level 2 | CPT 99282 | $5,379 |
| ED visit level 3 | CPT 99283 | $5,380 |
| ED visit level 4 | CPT 99284 | $5,381 |
| ED visit level 5 | CPT 99285 | $5,382 |
| Critical care, first hour | CPT 99291 | $5,399 |
| CT head without contrast | CPT 70450 | $5,914 |
| CT head with contrast | CPT 70460 | $5,967 |
| CT head with and without contrast | CPT 70470 | $5,967 |
| CT neck with contrast | CPT 70491 | $5,967 |
| MRI brain without contrast | CPT 70551 | $5,915 |
| MRI brain with and without contrast | CPT 70553 | $5,968 |
| Chest X-ray single view | CPT 71045 | $398.56 |
| Chest X-ray 2 views | CPT 71046 | $426.76 |
| CT chest without contrast | CPT 71250 | $5,914 |
| CT chest with contrast | CPT 71260 | $5,967 |
| CT chest with and without contrast | CPT 71270 | $5,967 |
| MRI chest without contrast | CPT 71550 | $5,915 |
| Lumbosacral spine X-ray | CPT 72100 | $442.74 |
| CT cervical spine without contrast | CPT 72125 | $5,914 |
| CT thoracic spine without contrast | CPT 72128 | $5,914 |
| CT lumbar spine without contrast | CPT 72131 | $5,914 |
| MRI cervical spine without contrast | CPT 72141 | $5,915 |
| MRI thoracic spine without contrast | CPT 72146 | $5,915 |
| MRI lumbar spine without contrast | CPT 72148 | $5,915 |
| MRI cervical spine with and without contrast | CPT 72156 | $5,968 |
| MRI lumbar spine with contrast | CPT 72158 | $5,968 |
| CT pelvis without contrast | CPT 72192 | $5,914 |
| CT pelvis with contrast | CPT 72193 | $5,967 |
| Shoulder X-ray | CPT 73030 | $390.1 |
| Humerus X-ray | CPT 73060 | $334.64 |
| Hand X-ray 3 views | CPT 73130 | $342.16 |
| MRI upper extremity joint without contrast | CPT 73221 | $5,915 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $5,968 |
| Knee X-ray 1-2 views | CPT 73560 | $308.32 |
| Ankle X-ray 3 views | CPT 73610 | $318.66 |
| MRI lower extremity joint without contrast | CPT 73721 | $5,915 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $5,968 |
| CT abdomen with contrast | CPT 74160 | $5,967 |
| CT abdomen with and without contrast | CPT 74170 | $5,967 |
| CT abdomen and pelvis without contrast | CPT 74176 | $5,915 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,968 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,968 |
| MRI abdomen without contrast | CPT 74181 | $5,915 |
| MRI abdomen with and without contrast | CPT 74183 | $5,968 |
| Abdominal ultrasound complete | CPT 76700 | $1,172.5 |
| Abdominal ultrasound limited | CPT 76705 | $894.45 |
| Retroperitoneal ultrasound complete | CPT 76770 | $894.45 |
| Obstetric ultrasound first trimester | CPT 76801 | $564.94 |
| Obstetric ultrasound after first trimester | CPT 76805 | $557.42 |
| Transvaginal ultrasound | CPT 76830 | $661.76 |
| Pelvic ultrasound complete | CPT 76856 | $1,046.04 |
| Scrotal ultrasound | CPT 76870 | $1,000.82 |
| Diagnostic mammography unilateral | CPT 77065 | $217.33 |
| Diagnostic mammography bilateral | CPT 77066 | $258.25 |
| Screening mammography bilateral | CPT 77067 | $219.76 |
| EKG tracing only | CPT 93005 | $6,140 |
| Transthoracic echocardiogram complete | CPT 93306 | $5,916 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $17,696 |
| COPD w MCC | MS-DRG 190 | $7,297 |
| COPD w CC | MS-DRG 191 | $5,582.23 |
| COPD w/o CC/MCC | MS-DRG 192 | $4,205.36 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $5,328.17 |
| AMI discharged alive w MCC | MS-DRG 280 | $10,665 |
| AMI discharged alive w CC | MS-DRG 281 | $5,989.64 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $4,711.53 |
| Heart failure & shock w MCC | MS-DRG 291 | $8,478.29 |
| Heart failure & shock w CC | MS-DRG 292 | $5,595.88 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $7,835.66 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $4,803.8 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $5,257.23 |
| GI hemorrhage w CC | MS-DRG 378 | $6,406.15 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $7,331.83 |
| Kidney/UTI w MCC | MS-DRG 689 | $7,604.34 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $5,215.11 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $12,749 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $6,699.2 |
| Basic metabolic panel (BMP) | CPT 80048 | $14.1 |
| Electrolyte panel | CPT 80051 | $11.37 |
| Comprehensive metabolic panel | CPT 80053 | $11.28 |
| Lipid panel | CPT 80061 | $46.33 |
| Renal function panel | CPT 80069 | $42.54 |
| Hepatic function panel | CPT 80076 | $42 |
| Urinalysis automated | CPT 81003 | $16.9 |
| Glucose quantitative | CPT 82947 | $20.75 |
| Hemoglobin A1c | CPT 83036 | $38.54 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $42.54 |
| Complete blood count with automated differential | CPT 85025 | $9.4 |
| Complete blood count without differential | CPT 85027 | $22.15 |
| Urine culture identification | CPT 87088 | $26.5 |
| Tissue exam by pathologist level IV | CPT 88305 | $6,074 |
| Fetal non-stress test | CPT 59025 | $5,795 |
| Vaginal delivery only | CPT 59409 | $5,798 |
| Upper GI endoscopy diagnostic | CPT 43235 | $5,677 |
| Upper GI endoscopy with biopsy | CPT 43239 | $5,677 |
| Sigmoidoscopy diagnostic | CPT 45330 | $5,688 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,997 |
| Colonoscopy diagnostic | CPT 45378 | $5,688 |
| Colonoscopy with biopsy | CPT 45380 | $5,689 |
| Colonoscopy with polyp removal | CPT 45385 | $5,689 |
| Total shoulder arthroplasty | CPT 23472 | $5,479 |
| Total hip replacement | CPT 27130 | $5,478 |
| Total knee replacement | CPT 27447 | $5,478 |
| Knee revision arthroplasty single component | CPT 27486 | — |
| Shoulder arthroscopy with decompression | CPT 29826 | $5,637 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $5,477 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $5,476 |
| ACL reconstruction | CPT 29888 | $5,477 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $29,837 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $22,211 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $15,513 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $10,776 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $8,561.46 |
| Laparoscopic appendectomy | CPT 44970 | $5,742 |
| Major joint replacement w/o MCC | MS-DRG 470 | $17,717 |
| Laparoscopic cholecystectomy | CPT 47562 | $9,866 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $5,742 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $19,110 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $13,482 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $10,308 |
| Open umbilical hernia repair | CPT 49560 | $10,315 |
| Umbilical hernia repair age 5+ | CPT 49585 | $9,028 |
| Lap inguinal hernia repair | CPT 49650 | $5,742 |
| Total abdominal hysterectomy | CPT 58150 | $13,993 |
| Vaginal hysterectomy | CPT 58260 | $5,799 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $5,742 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $5,743 |
| Lap salpingo-oophorectomy | CPT 58661 | $5,742 |
| OR procedure for obesity w MCC | MS-DRG 619 | $17,716 |
| OR procedure for obesity w CC | MS-DRG 620 | $15,006 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $9,498.44 |
| Complex cataract surgery | CPT 66982 | $5,881 |
| Cataract surgery with lens implant | CPT 66984 | $5,881 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $11,264 |
