| Psychoses | MS-DRG 885 | $15,004 |
| ED visit level 1 | CPT 99281 | $703.25 |
| ED visit level 2 | CPT 99282 | $703.25 |
| ED visit level 3 | CPT 99283 | $703.25 |
| ED visit level 4 | CPT 99284 | $703.25 |
| ED visit level 5 | CPT 99285 | $703.25 |
| Critical care, first hour | CPT 99291 | $703.25 |
| CT head without contrast | CPT 70450 | $208.44 |
| CT head with and without contrast | CPT 70470 | $364.13 |
| CT neck with contrast | CPT 70491 | $411.48 |
| Chest X-ray single view | CPT 71045 | $17.41 |
| Chest X-ray 2 views | CPT 71046 | $23.07 |
| Chest X-ray 3 views | CPT 71047 | $27.67 |
| CT chest without contrast | CPT 71250 | $320.07 |
| CT chest with contrast | CPT 71260 | $476.77 |
| Lumbosacral spine X-ray | CPT 72100 | $49.03 |
| CT cervical spine without contrast | CPT 72125 | $320.07 |
| CT thoracic spine without contrast | CPT 72128 | $320.07 |
| CT lumbar spine without contrast | CPT 72131 | $320.07 |
| CT pelvis without contrast | CPT 72192 | $259.65 |
| CT pelvis with contrast | CPT 72193 | $478.81 |
| Shoulder X-ray | CPT 73030 | $41.94 |
| Humerus X-ray | CPT 73060 | $41.94 |
| Hand X-ray 3 views | CPT 73130 | $38.5 |
| Knee X-ray 1-2 views | CPT 73560 | $37.81 |
| Ankle X-ray 3 views | CPT 73610 | $38.5 |
| CT abdomen with and without contrast | CPT 74170 | $548.46 |
| CT abdomen and pelvis without contrast | CPT 74176 | $305.97 |
| CT abdomen and pelvis with contrast | CPT 74177 | $523.64 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $663.51 |
| Abdominal ultrasound complete | CPT 76700 | $145.93 |
| Abdominal ultrasound limited | CPT 76705 | $109.94 |
| Retroperitoneal ultrasound complete | CPT 76770 | $144.61 |
| Obstetric ultrasound first trimester | CPT 76801 | $131.39 |
| Obstetric ultrasound after first trimester | CPT 76805 | $153.11 |
| Transvaginal ultrasound | CPT 76830 | $125.68 |
| Pelvic ultrasound complete | CPT 76856 | $126.3 |
| Scrotal ultrasound | CPT 76870 | $101.94 |
| EKG tracing only | CPT 93005 | $31.7 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $40,112 |
| COPD w MCC | MS-DRG 190 | $17,596 |
| COPD w CC | MS-DRG 191 | $17,596 |
| COPD w/o CC/MCC | MS-DRG 192 | $17,596 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $22,644 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $18,024 |
| AMI discharged alive w MCC | MS-DRG 280 | $31,850 |
| AMI discharged alive w CC | MS-DRG 281 | $27,538 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $24,115 |
| Heart failure & shock w MCC | MS-DRG 291 | $27,143 |
| Heart failure & shock w CC | MS-DRG 292 | $27,143 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $27,143 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $20,097 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $18,861 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $14,456 |
| GI hemorrhage w CC | MS-DRG 378 | $20,328 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $15,588 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $13,856 |
| Fractures of femur w/o MCC | MS-DRG 533 | $11,607 |
| Kidney/UTI w MCC | MS-DRG 689 | $16,696 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $14,255 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $38,856 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $38,835 |
| Basic metabolic panel (BMP) | CPT 80048 | $20.08 |
| Electrolyte panel | CPT 80051 | $16.64 |
| Comprehensive metabolic panel | CPT 80053 | $25.1 |
| Lipid panel | CPT 80061 | $31.76 |
| Renal function panel | CPT 80069 | $20.63 |
| Hepatic function panel | CPT 80076 | $19.39 |
| Urinalysis non-automated | CPT 81002 | $6.05 |
| Glucose quantitative | CPT 82947 | $9.29 |
| Hemoglobin A1c | CPT 83036 | $23.04 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $39.88 |
| Complete blood count with automated differential | CPT 85025 | $18.43 |
| Complete blood count without differential | CPT 85027 | $15.34 |
| Urine culture bacterial | CPT 87086 | $19.19 |
| Urine culture identification | CPT 87088 | $18.15 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $76,687 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $62,081 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $34,772 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $25,687 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $16,617 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $62,316 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $80,196 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $75,463 |
| Major joint replacement w MCC | MS-DRG 469 | $38,988 |
| Major joint replacement w/o MCC | MS-DRG 470 | $26,470 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $47,362 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $46,189 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $33,285 |
| OR procedure for obesity w MCC | MS-DRG 619 | $49,231 |
| OR procedure for obesity w CC | MS-DRG 620 | $49,231 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $49,017 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $19,063 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $14,896 |
