| Psychiatric eval with medical services | CPT 90792 | $56.97 |
| Psychotherapy 30 minutes | CPT 90832 | $35.87 |
| Psychotherapy 45 minutes | CPT 90834 | $48.53 |
| Psychotherapy 60 minutes | CPT 90837 | $65.41 |
| ED visit level 1 | CPT 99281 | $47.67 |
| ED visit level 2 | CPT 99282 | $93.93 |
| ED visit level 3 | CPT 99283 | $127.26 |
| ED visit level 4 | CPT 99284 | $191.8 |
| ED visit level 5 | CPT 99285 | $274.94 |
| CT head without contrast | CPT 70450 | $506.61 |
| CT head with contrast | CPT 70460 | $554.72 |
| CT head with and without contrast | CPT 70470 | $787.88 |
| CT neck with contrast | CPT 70491 | $649.46 |
| MRI brain without contrast | CPT 70551 | $1,058.59 |
| MRI brain with and without contrast | CPT 70553 | $1,520.05 |
| Chest X-ray single view | CPT 71045 | $75.12 |
| Chest X-ray 2 views | CPT 71046 | $88.41 |
| CT chest without contrast | CPT 71250 | $623.51 |
| CT chest with contrast | CPT 71260 | $852.02 |
| CT chest with and without contrast | CPT 71270 | $1,019.77 |
| MRI chest without contrast | CPT 71550 | $1,058.59 |
| MRI chest with and without contrast | CPT 71552 | $1,127.16 |
| Lumbosacral spine X-ray | CPT 72100 | $93.48 |
| CT cervical spine without contrast | CPT 72125 | $692.72 |
| CT thoracic spine without contrast | CPT 72128 | $706.85 |
| CT lumbar spine without contrast | CPT 72131 | $657.27 |
| MRI cervical spine without contrast | CPT 72141 | $1,008.16 |
| MRI thoracic spine without contrast | CPT 72146 | $1,127.16 |
| MRI lumbar spine without contrast | CPT 72148 | $1,073.78 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,606.56 |
| MRI lumbar spine with contrast | CPT 72158 | $1,320.44 |
| CT pelvis without contrast | CPT 72192 | $597.98 |
| Shoulder X-ray | CPT 73030 | $81.03 |
| Humerus X-ray | CPT 73060 | $81.03 |
| Hand X-ray 3 views | CPT 73130 | $81.45 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,008.16 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,058.59 |
| Knee X-ray 1-2 views | CPT 73560 | $76.81 |
| Ankle X-ray 3 views | CPT 73610 | $88.41 |
| MRI lower extremity joint without contrast | CPT 73721 | $715.08 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,152.48 |
| CT abdomen without contrast | CPT 74150 | $539.11 |
| CT abdomen with contrast | CPT 74160 | $665.5 |
| CT abdomen with and without contrast | CPT 74170 | $793.57 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,136.24 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,493.67 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,740.12 |
| MRI abdomen without contrast | CPT 74181 | $839.15 |
| MRI abdomen with and without contrast | CPT 74183 | $880.93 |
| Abdominal ultrasound complete | CPT 76700 | $301.52 |
| Abdominal ultrasound limited | CPT 76705 | $182.52 |
| Obstetric ultrasound first trimester | CPT 76801 | $284.64 |
| Pelvic ultrasound complete | CPT 76856 | $251.73 |
| Scrotal ultrasound | CPT 76870 | $284.64 |
| EKG tracing only | CPT 93005 | $83.77 |
| Transthoracic echocardiogram complete | CPT 93306 | $835.77 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $21,265 |
| COPD w MCC | MS-DRG 190 | $15,074 |
| COPD w CC | MS-DRG 191 | $11,472 |
| COPD w/o CC/MCC | MS-DRG 192 | $8,736.34 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $10,967 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $8,552.63 |
| AMI discharged alive w MCC | MS-DRG 280 | $21,829 |
| AMI discharged alive w CC | MS-DRG 281 | $12,507 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $9,839.94 |
| Heart failure & shock w MCC | MS-DRG 291 | $17,470 |
| Heart failure & shock w CC | MS-DRG 292 | $11,553 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $7,702.13 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $16,384 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $7,703.49 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $10,609 |
| Kidney/UTI w MCC | MS-DRG 689 | $15,789 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $11,016 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $26,434 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $13,925 |
| Basic metabolic panel (BMP) | CPT 80048 | $50.1 |
| Electrolyte panel | CPT 80051 | $39.39 |
| Comprehensive metabolic panel | CPT 80053 | $58.18 |
| Lipid panel | CPT 80061 | $83.02 |
| Renal function panel | CPT 80069 | $71.91 |
| Hepatic function panel | CPT 80076 | $63.83 |
| Urinalysis non-automated | CPT 81002 | $4.65 |
| Urinalysis automated | CPT 81003 | $19.36 |
| Glucose quantitative | CPT 82947 | $44.04 |
| Hemoglobin A1c | CPT 83036 | $27.07 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $62.01 |
| Complete blood count with automated differential | CPT 85025 | $27.67 |
| Complete blood count without differential | CPT 85027 | $21.61 |
| Urine culture bacterial | CPT 87086 | $43.03 |
| Tissue exam by pathologist level IV | CPT 88305 | $34.61 |
| Vaginal delivery only | CPT 59409 | $1,241.02 |
| Office visit, established patient, 5 min | CPT 99211 | $145.38 |
