| Psychoses | MS-DRG 885 | $17,905 |
| ED visit level 1 | CPT 99281 | $80 |
| ED visit level 2 | CPT 99282 | $80 |
| ED visit level 3 | CPT 99283 | $80 |
| ED visit level 4 | CPT 99284 | $80 |
| ED visit level 5 | CPT 99285 | $80 |
| Critical care, first hour | CPT 99291 | $80 |
| CT head without contrast | CPT 70450 | $139.1 |
| CT head with contrast | CPT 70460 | $186.48 |
| CT head with and without contrast | CPT 70470 | $232.9 |
| CT neck with contrast | CPT 70491 | $186.48 |
| MRI brain without contrast | CPT 70551 | $396.85 |
| MRI brain with contrast | CPT 70552 | $442.34 |
| MRI brain with and without contrast | CPT 70553 | $760.83 |
| Chest X-ray single view | CPT 71045 | $31.02 |
| Chest X-ray 2 views | CPT 71046 | $41.09 |
| Chest X-ray 3 views | CPT 71047 | $49.29 |
| CT chest without contrast | CPT 71250 | — |
| CT chest with contrast | CPT 71260 | $232.9 |
| CT chest with and without contrast | CPT 71270 | $291.1 |
| MRI chest without contrast | CPT 71550 | $372.23 |
| MRI chest with contrast | CPT 71551 | $414.97 |
| MRI chest with and without contrast | CPT 71552 | $704.71 |
| Lumbosacral spine X-ray | CPT 72100 | $54.02 |
| CT cervical spine without contrast | CPT 72125 | $194.84 |
| CT thoracic spine without contrast | CPT 72128 | $194.84 |
| CT lumbar spine without contrast | CPT 72131 | $177.96 |
| MRI cervical spine without contrast | CPT 72141 | $381.36 |
| MRI thoracic spine without contrast | CPT 72146 | $388.54 |
| MRI lumbar spine without contrast | CPT 72148 | $401.86 |
| MRI lumbar spine with and without contrast | CPT 72149 | $442.34 |
| MRI cervical spine with and without contrast | CPT 72156 | $733.84 |
| MRI lumbar spine with contrast | CPT 72158 | $731.66 |
| CT pelvis without contrast | CPT 72192 | $194.84 |
| CT pelvis with contrast | CPT 72193 | $235.33 |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | — |
| Hand X-ray 3 views | CPT 73130 | $45.68 |
| MRI upper extremity joint without contrast | CPT 73221 | $414 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $918.98 |
| Knee X-ray 1-2 views | CPT 73560 | $41.36 |
| Ankle X-ray 3 views | CPT 73610 | — |
| MRI lower extremity joint without contrast | CPT 73721 | $396.1 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $707.76 |
| CT abdomen without contrast | CPT 74150 | $186.48 |
| CT abdomen with contrast | CPT 74160 | $235.33 |
| CT abdomen with and without contrast | CPT 74170 | $279.37 |
| CT abdomen and pelvis without contrast | CPT 74176 | — |
| CT abdomen and pelvis with contrast | CPT 74177 | $216.98 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $243.48 |
| MRI abdomen without contrast | CPT 74181 | $369.03 |
| MRI abdomen with and without contrast | CPT 74183 | $709.06 |
| Abdominal ultrasound complete | CPT 76700 | $85 |
| Abdominal ultrasound limited | CPT 76705 | $85 |
| Retroperitoneal ultrasound complete | CPT 76770 | $85 |
| Obstetric ultrasound first trimester | CPT 76801 | $85 |
| Obstetric ultrasound after first trimester | CPT 76805 | $93.79 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $127.03 |
| Transvaginal ultrasound | CPT 76830 | $85 |
| Pelvic ultrasound complete | CPT 76856 | $85 |
| Scrotal ultrasound | CPT 76870 | $85 |
| Diagnostic mammography unilateral | CPT 77065 | $85.82 |
| Diagnostic mammography bilateral | CPT 77066 | $108.6 |
| Screening mammography bilateral | CPT 77067 | — |
| EKG tracing only | CPT 93005 | $80 |
| Transthoracic echocardiogram complete | CPT 93306 | — |
| Stress echocardiogram | CPT 93350 | $82.5 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $5,521 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $5,521 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $5,521 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $17,921 |
| COPD w MCC | MS-DRG 190 | $12,564 |
| COPD w CC | MS-DRG 191 | $9,589.11 |
| COPD w/o CC/MCC | MS-DRG 192 | $7,259.77 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $9,159.24 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $7,040.83 |
| AMI discharged alive w MCC | MS-DRG 280 | $18,287 |
| AMI discharged alive w CC | MS-DRG 281 | $10,364 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $8,153.38 |
| Heart failure & shock w MCC | MS-DRG 291 | $14,582 |
| Heart failure & shock w CC | MS-DRG 292 | $9,632.93 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $6,481.51 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $13,567 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $8,304.98 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $6,547.23 |
| GI hemorrhage w CC | MS-DRG 378 | $11,073 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $7,135.86 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $8,781.59 |
| Fractures of femur w/o MCC | MS-DRG 533 | $17,390 |
| Kidney/UTI w MCC | MS-DRG 689 | $13,124 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $9,071.98 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $21,989 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $11,568 |
| Basic metabolic panel (BMP) | CPT 80048 | $12.05 |
| General health panel | CPT 80050 | $77.7 |
| Electrolyte panel | CPT 80051 | $9.98 |
| Comprehensive metabolic panel | CPT 80053 | $15.05 |
| Lipid panel | CPT 80061 | $19.07 |
| Renal function panel | CPT 80069 | $12.36 |
| Hepatic function panel | CPT 80076 | $11.63 |
| Urinalysis non-automated | CPT 81002 | $4.18 |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | — |
| Hemoglobin A1c | CPT 83036 | $13.82 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | — |
| Complete blood count with automated differential | CPT 85025 | $11.06 |
| Complete blood count without differential | CPT 85027 | — |
| Urine culture bacterial | CPT 87086 | — |
| Urine culture identification | CPT 87088 | — |
| Tissue exam by pathologist level IV | CPT 88305 | $64.84 |
| Fetal non-stress test | CPT 59025 | $54.31 |
| Office visit, established patient, 5 min | CPT 99211 | — |
| Office visit, established patient, 10-19 min | CPT 99212 | $80 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $80 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $43,769 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $26,786 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $18,753 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $18,843 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $15,084 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $39,105 |
| Major joint replacement w MCC | MS-DRG 469 | $10,797 |
| Major joint replacement w/o MCC | MS-DRG 470 | $10,797 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $32,964 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $23,462 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $18,092 |
| OR procedure for obesity w MCC | MS-DRG 619 | $31,529 |
| OR procedure for obesity w CC | MS-DRG 620 | $17,997 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $16,699 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $13,882 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $22,492 |
