| Critical care, first hour | CPT 99291 | $3,461.64 |
| CT head without contrast | CPT 70450 | $8,189.82 |
| CT head with contrast | CPT 70460 | $3,640.95 |
| CT head with and without contrast | CPT 70470 | $8,225.20 |
| CT neck with contrast | CPT 70491 | $7,784.10 |
| MRI brain without contrast | CPT 70551 | $7,041.68 |
| MRI brain with contrast | CPT 70552 | $7,500.36 |
| MRI brain with and without contrast | CPT 70553 | $7,957.36 |
| Chest X-ray single view | CPT 71045 | $1,458.89 |
| Chest X-ray 2 views | CPT 71046 | $1,171.80 |
| Chest X-ray 3 views | CPT 71047 | $1,255.50 |
| CT chest without contrast | CPT 71250 | $8,359.96 |
| CT chest with contrast | CPT 71260 | $9,459.78 |
| CT chest with and without contrast | CPT 71270 | $7,080.40 |
| Lumbosacral spine X-ray | CPT 72100 | $1,748.98 |
| CT cervical spine without contrast | CPT 72125 | $3,640.95 |
| CT thoracic spine without contrast | CPT 72128 | $6,919.48 |
| CT lumbar spine without contrast | CPT 72131 | $3,640.95 |
| MRI cervical spine without contrast | CPT 72141 | $9,105.73 |
| MRI thoracic spine without contrast | CPT 72146 | $8,354.10 |
| MRI lumbar spine without contrast | CPT 72148 | $4,370.82 |
| MRI lumbar spine with and without contrast | CPT 72149 | $5,622.63 |
| MRI cervical spine with and without contrast | CPT 72156 | $10,361 |
| MRI lumbar spine with contrast | CPT 72158 | $11,288 |
| CT pelvis without contrast | CPT 72192 | $8,359.96 |
| CT pelvis with contrast | CPT 72193 | $9,057.18 |
| Shoulder X-ray | CPT 73030 | $1,748.98 |
| Humerus X-ray | CPT 73060 | $1,212.82 |
| Hand X-ray 3 views | CPT 73130 | $1,212.82 |
| MRI upper extremity joint without contrast | CPT 73221 | $4,047.05 |
| Knee X-ray 1-2 views | CPT 73560 | $1,458.89 |
| Ankle X-ray 3 views | CPT 73610 | $1,604.49 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $10,504 |
| CT abdomen without contrast | CPT 74150 | $8,359.96 |
| CT abdomen with contrast | CPT 74160 | $9,346.78 |
| CT abdomen with and without contrast | CPT 74170 | $10,375 |
| CT abdomen and pelvis without contrast | CPT 74176 | $5,632.18 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,861.51 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $11,532 |
| MRI abdomen without contrast | CPT 74181 | $5,676.10 |
| Abdominal ultrasound complete | CPT 76700 | $3,362.48 |
| Abdominal ultrasound limited | CPT 76705 | $881.22 |
| Retroperitoneal ultrasound complete | CPT 76770 | $4,046.82 |
| Pelvic ultrasound complete | CPT 76856 | $3,411.65 |
| Scrotal ultrasound | CPT 76870 | $1,530.04 |
| Screening mammography bilateral | CPT 77067 | $1,262.31 |
| EKG tracing only | CPT 93005 | $196.28 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,473.89 |
| Transthoracic echocardiogram | CPT 93307 | $2,248.28 |
| Stress echocardiogram | CPT 93350 | $3,238.73 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $57,101 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $29,916 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $20,983 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $35,583 |
| COPD w MCC | MS-DRG 190 | $28,687 |
| COPD w CC | MS-DRG 191 | $28,687 |
| COPD w/o CC/MCC | MS-DRG 192 | $28,687 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $23,415 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $20,983 |
| AMI discharged alive w MCC | MS-DRG 280 | $35,991 |
| AMI discharged alive w CC | MS-DRG 281 | $28,037 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $20,983 |
| Heart failure & shock w MCC | MS-DRG 291 | $33,779 |
| Heart failure & shock w CC | MS-DRG 292 | $23,985 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $20,983 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $36,751 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $20,983 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $20,983 |
| GI hemorrhage w CC | MS-DRG 378 | $28,037 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $28,037 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $27,497 |
| Fractures of femur w/o MCC | MS-DRG 533 | $31,843 |
| Kidney/UTI w MCC | MS-DRG 689 | $27,734 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $20,632 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $37,264 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $24,969 |
| Basic metabolic panel (BMP) | CPT 80048 | $427.12 |
| Electrolyte panel | CPT 80051 | $354.05 |
| Comprehensive metabolic panel | CPT 80053 | $424.41 |
| Lipid panel | CPT 80061 | $1,155.65 |
| Renal function panel | CPT 80069 | $462.85 |
| Hepatic function panel | CPT 80076 | $1,218.98 |
| Urinalysis non-automated | CPT 81002 | $26.97 |
| Urinalysis automated | CPT 81003 | $46.11 |
| Glucose quantitative | CPT 82947 | $400.48 |
| Hemoglobin A1c | CPT 83036 | $567.11 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $1,132.26 |
| Complete blood count with automated differential | CPT 85025 | $263.06 |
| Complete blood count without differential | CPT 85027 | $263.06 |
| Urine culture bacterial | CPT 87086 | $850.66 |
| Urine culture identification | CPT 87088 | $369.31 |
| Tissue exam by pathologist level IV | CPT 88305 | $1,562.96 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,985.80 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,908.36 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,313.26 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,313.26 |
| Colonoscopy diagnostic | CPT 45378 | $2,124.31 |
| Colonoscopy with biopsy | CPT 45380 | $4,612.71 |
| Colonoscopy with polyp removal | CPT 45385 | $4,612.71 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $55,411 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $28,037 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $28,037 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $31,843 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $31,843 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $31,566 |
| Major joint replacement w MCC | MS-DRG 469 | $55,411 |
| Major joint replacement w/o MCC | MS-DRG 470 | $29,916 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $29,916 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $29,916 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $29,916 |
| OR procedure for obesity w MCC | MS-DRG 619 | $57,400 |
| OR procedure for obesity w CC | MS-DRG 620 | $41,645 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $29,916 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $55,411 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $55,411 |
