| Psychoses | MS-DRG 885 | $13,328 |
| Psychotherapy 30 minutes | CPT 90832 | $292.99 |
| Psychotherapy 45 minutes | CPT 90834 | $323.7 |
| Psychotherapy 60 minutes | CPT 90837 | $355.24 |
| ED visit level 1 | CPT 99281 | $225.7 |
| ED visit level 2 | CPT 99282 | $360.12 |
| ED visit level 3 | CPT 99283 | $578.03 |
| ED visit level 4 | CPT 99284 | $938.86 |
| ED visit level 5 | CPT 99285 | $1,390.62 |
| Critical care, first hour | CPT 99291 | $2,107.98 |
| CT head without contrast | CPT 70450 | $1,449.21 |
| CT head with contrast | CPT 70460 | $1,742.67 |
| CT head with and without contrast | CPT 70470 | $2,188.22 |
| CT neck with contrast | CPT 70491 | $1,963.77 |
| MRI brain without contrast | CPT 70551 | $2,505.8 |
| MRI brain with contrast | CPT 70552 | $2,901.77 |
| MRI brain with and without contrast | CPT 70553 | $3,373.45 |
| Chest X-ray single view | CPT 71045 | $272.69 |
| Chest X-ray 2 views | CPT 71046 | $286.76 |
| Chest X-ray 3 views | CPT 71047 | $300.3 |
| CT chest without contrast | CPT 71250 | $1,553.73 |
| CT chest with contrast | CPT 71260 | $2,083.7 |
| CT chest with and without contrast | CPT 71270 | $2,282.69 |
| MRI chest without contrast | CPT 71550 | $2,296.76 |
| MRI chest with and without contrast | CPT 71552 | $3,494.72 |
| Lumbosacral spine X-ray | CPT 72100 | $302.84 |
| CT cervical spine without contrast | CPT 72125 | $1,553.73 |
| CT thoracic spine without contrast | CPT 72128 | $1,553.73 |
| CT lumbar spine without contrast | CPT 72131 | $1,519.56 |
| MRI cervical spine without contrast | CPT 72141 | $2,551.36 |
| MRI thoracic spine without contrast | CPT 72146 | $2,551.36 |
| MRI lumbar spine without contrast | CPT 72148 | $2,551.36 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,351.34 |
| MRI lumbar spine with contrast | CPT 72158 | $3,442.46 |
| CT pelvis without contrast | CPT 72192 | $1,406.33 |
| CT pelvis with contrast | CPT 72193 | $1,723.91 |
| Shoulder X-ray | CPT 73030 | $266.66 |
| Humerus X-ray | CPT 73060 | $228.47 |
| Hand X-ray 3 views | CPT 73130 | $233.83 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,802.61 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,335.26 |
| Knee X-ray 1-2 views | CPT 73560 | $210.38 |
| Ankle X-ray 3 views | CPT 73610 | $217.75 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,473.64 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,253.52 |
| CT abdomen without contrast | CPT 74150 | $1,512.19 |
| CT abdomen with contrast | CPT 74160 | $2,375.15 |
| CT abdomen with and without contrast | CPT 74170 | $2,663.92 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,785.86 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,665.57 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,546.98 |
| MRI abdomen without contrast | CPT 74181 | $2,794.57 |
| MRI abdomen with and without contrast | CPT 74183 | $3,398.91 |
| Abdominal ultrasound complete | CPT 76700 | $900.48 |
| Abdominal ultrasound limited | CPT 76705 | $686.75 |
| Retroperitoneal ultrasound complete | CPT 76770 | $686.75 |
| Obstetric ultrasound first trimester | CPT 76801 | $386.59 |
| Obstetric ultrasound after first trimester | CPT 76805 | $381.23 |
| Transvaginal ultrasound | CPT 76830 | $452.25 |
| Pelvic ultrasound complete | CPT 76856 | $803.33 |
| Scrotal ultrasound | CPT 76870 | $768.49 |
| Screening mammography bilateral | CPT 77067 | $451.2 |
| EKG tracing only | CPT 93005 | $188.27 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,873.32 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $19,538 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $9,914.22 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $6,706.03 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $16,547 |
| COPD w MCC | MS-DRG 190 | $10,749 |
| COPD w CC | MS-DRG 191 | $8,115.73 |
| COPD w/o CC/MCC | MS-DRG 192 | $6,260.28 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $8,019.95 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $5,980.21 |
| AMI discharged alive w MCC | MS-DRG 280 | $15,475 |
| AMI discharged alive w CC | MS-DRG 281 | $8,727.52 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $7,004.52 |
| Heart failure & shock w MCC | MS-DRG 291 | $12,523 |
| Heart failure & shock w CC | MS-DRG 292 | $8,354.51 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $11,727 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $7,264 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $5,394.1 |
| GI hemorrhage w CC | MS-DRG 378 | $9,596.23 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $6,176.39 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $7,662.94 |
| Fractures of femur w/o MCC | MS-DRG 533 | $15,913 |
| Kidney/UTI w MCC | MS-DRG 689 | $11,455 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $7,713.29 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $19,289 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $10,046 |
| Basic metabolic panel (BMP) | CPT 80048 | $137.6 |
| Electrolyte panel | CPT 80051 | $96 |
| Comprehensive metabolic panel | CPT 80053 | $153.6 |
| Lipid panel | CPT 80061 | $103.2 |
| Renal function panel | CPT 80069 | $133.6 |
| Hepatic function panel | CPT 80076 | $133.6 |
| Urinalysis automated | CPT 81003 | $31.02 |
| Glucose quantitative | CPT 82947 | $46.86 |
| Hemoglobin A1c | CPT 83036 | $32.8 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $104 |
| Complete blood count with automated differential | CPT 85025 | $103.2 |
| Complete blood count without differential | CPT 85027 | $81.6 |
| Urine culture identification | CPT 87088 | $61.6 |
| Tissue exam by pathologist level IV | CPT 88305 | $180.8 |
| Fetal non-stress test | CPT 59025 | $522.72 |
| Vaginal delivery only | CPT 59409 | $2,783.77 |
| C-section delivery only | CPT 59514 | $4,660.45 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,201.04 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,902.63 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,720.08 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,346.09 |
| Colonoscopy diagnostic | CPT 45378 | $2,864.52 |
| Colonoscopy with biopsy | CPT 45380 | $4,256.08 |
| Colonoscopy with polyp removal | CPT 45385 | $4,332.05 |
| Total shoulder arthroplasty | CPT 23472 | $53,021 |
| Total hip replacement | CPT 27130 | $36,747 |
| Total knee replacement | CPT 27447 | $35,378 |
| Shoulder arthroscopy with decompression | CPT 29826 | $34,304 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $27,915 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $10,775 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $44,058 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $23,138 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $16,309 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $15,945 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $12,809 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $31,221 |
| Laparoscopic appendectomy | CPT 44970 | $13,038 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $64,693 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $35,680 |
| Major joint replacement w MCC | MS-DRG 469 | $32,480 |
| Major joint replacement w/o MCC | MS-DRG 470 | $18,355 |
| Laparoscopic cholecystectomy | CPT 47562 | $17,115 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $17,919 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $28,764 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $20,239 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $15,494 |
| Open umbilical hernia repair | CPT 49560 | $19,866 |
| Lap inguinal hernia repair | CPT 49650 | $21,117 |
| Lap incisional hernia repair | CPT 49652 | $23,852 |
| Lap salpingo-oophorectomy | CPT 58661 | $19,422 |
| OR procedure for obesity w CC | MS-DRG 620 | $15,823 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $14,800 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $11,334 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $18,361 |
| PCI single major coronary artery | CPT 92920 | $11,212 |
| Coronary angiography with cath | CPT 93455 | $8,008.44 |
| Coronary angiography with bypass cath | CPT 93458 | $8,642.13 |
