| Psychoses | MS-DRG 885 | $16,467 |
| Psychiatric diagnostic evaluation | CPT 90791 | $29 |
| ED visit level 1 | CPT 99281 | $54.46 |
| ED visit level 2 | CPT 99282 | $76.8 |
| ED visit level 3 | CPT 99283 | $76.8 |
| ED visit level 4 | CPT 99284 | $76.8 |
| ED visit level 5 | CPT 99285 | $76.8 |
| Critical care, first hour | CPT 99291 | $29 |
| CT head without contrast | CPT 70450 | $77.7 |
| CT head with contrast | CPT 70460 | $743.73 |
| CT head with and without contrast | CPT 70470 | $1,001.02 |
| CT neck with contrast | CPT 70491 | $29.66 |
| MRI brain without contrast | CPT 70551 | $53.56 |
| MRI brain with contrast | CPT 70552 | $1,906.48 |
| MRI brain with and without contrast | CPT 70553 | $53.56 |
| Chest X-ray single view | CPT 71045 | $53.53 |
| Chest X-ray 2 views | CPT 71046 | $90.7 |
| Chest X-ray 3 views | CPT 71047 | $124.9 |
| CT chest without contrast | CPT 71250 | $53.56 |
| CT chest with contrast | CPT 71260 | $76.8 |
| CT chest with and without contrast | CPT 71270 | $1,521.96 |
| MRI chest without contrast | CPT 71550 | $1,725.03 |
| MRI chest with contrast | CPT 71551 | $2,118.32 |
| MRI chest with and without contrast | CPT 71552 | $2,668.87 |
| Lumbosacral spine X-ray | CPT 72100 | $63.7 |
| CT cervical spine without contrast | CPT 72125 | $76.8 |
| CT thoracic spine without contrast | CPT 72128 | $690.16 |
| CT lumbar spine without contrast | CPT 72131 | $363.4 |
| MRI cervical spine without contrast | CPT 72141 | $76.8 |
| MRI thoracic spine without contrast | CPT 72146 | $900 |
| MRI lumbar spine without contrast | CPT 72148 | $53.56 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,906.48 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,136.55 |
| MRI lumbar spine with contrast | CPT 72158 | $1,384.75 |
| CT pelvis without contrast | CPT 72192 | $90.7 |
| CT pelvis with contrast | CPT 72193 | $340.16 |
| Shoulder X-ray | CPT 73030 | $70.25 |
| Humerus X-ray | CPT 73060 | $63.7 |
| Hand X-ray 3 views | CPT 73130 | $76.8 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,552.52 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,592.99 |
| Knee X-ray 1-2 views | CPT 73560 | $69.74 |
| Ankle X-ray 3 views | CPT 73610 | $70.25 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,552.52 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,586.43 |
| CT abdomen without contrast | CPT 74150 | $681.69 |
| CT abdomen with contrast | CPT 74160 | $650 |
| CT abdomen with and without contrast | CPT 74170 | $76.8 |
| CT abdomen and pelvis without contrast | CPT 74176 | $76.8 |
| CT abdomen and pelvis with contrast | CPT 74177 | $77.7 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $340.16 |
| MRI abdomen without contrast | CPT 74181 | $1,552.52 |
| MRI abdomen with and without contrast | CPT 74183 | $2,403.63 |
| Abdominal ultrasound complete | CPT 76700 | $29.66 |
| Abdominal ultrasound limited | CPT 76705 | $70.25 |
| Retroperitoneal ultrasound complete | CPT 76770 | $47.01 |
| Obstetric ultrasound first trimester | CPT 76801 | $320.34 |
| Obstetric ultrasound after first trimester | CPT 76805 | $475.52 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $563.1 |
| Transvaginal ultrasound | CPT 76830 | $70.25 |
| Pelvic ultrasound complete | CPT 76856 | $63.7 |
| Scrotal ultrasound | CPT 76870 | $63.7 |
| Diagnostic mammography unilateral | CPT 77065 | $78.6 |
| Diagnostic mammography bilateral | CPT 77066 | $71.15 |
| Screening mammography bilateral | CPT 77067 | $77.7 |
| Transthoracic echocardiogram complete | CPT 93306 | $29 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $23,708 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $9,093.64 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $8,068.38 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $14,143 |
| COPD w MCC | MS-DRG 190 | $7,730.65 |
| COPD w CC | MS-DRG 191 | $8,014.46 |
| COPD w/o CC/MCC | MS-DRG 192 | $7,568.53 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $6,276.87 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $6,170.6 |
| AMI discharged alive w MCC | MS-DRG 280 | $18,911 |
| AMI discharged alive w CC | MS-DRG 281 | $10,835 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $8,524.61 |
| Heart failure & shock w MCC | MS-DRG 291 | $8,518.61 |
| Heart failure & shock w CC | MS-DRG 292 | $8,254.95 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $5,690.11 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $7,621.92 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $5,388.03 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $6,673.74 |
| GI hemorrhage w CC | MS-DRG 378 | $11,561 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $7,431.77 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $7,397.52 |
| Fractures of femur w/o MCC | MS-DRG 533 | $18,482 |
| Kidney/UTI w MCC | MS-DRG 689 | $11,099 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $9,543.18 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $11,245 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $7,621.92 |
| Basic metabolic panel (BMP) | CPT 80048 | $66.1 |
| General health panel | CPT 80050 | $463.15 |
| Electrolyte panel | CPT 80051 | $57.32 |
| Comprehensive metabolic panel | CPT 80053 | $70.25 |
| Lipid panel | CPT 80061 | $70.25 |
| Renal function panel | CPT 80069 | $47.01 |
| Hepatic function panel | CPT 80076 | $63.7 |
| Urinalysis non-automated | CPT 81002 | $29 |
| Urinalysis automated | CPT 81003 | $29 |
| Glucose quantitative | CPT 82947 | $32.07 |
| Hemoglobin A1c | CPT 83036 | $63.7 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $70.25 |
| Complete blood count with automated differential | CPT 85025 | $62.9 |
| Complete blood count without differential | CPT 85027 | $52.37 |
| Urine culture identification | CPT 87088 | $64.6 |
| Tissue exam by pathologist level IV | CPT 88305 | $90 |
| Office visit, new patient, 15-29 min | CPT 99202 | $76.8 |
| Office visit, established patient, 5 min | CPT 99211 | $29 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $54,188 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $28,261 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $19,840 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $19,942 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $16,101 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $40,166 |
| Major joint replacement w MCC | MS-DRG 469 | $35,758 |
| Major joint replacement w/o MCC | MS-DRG 470 | $22,740 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $34,333 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $24,692 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $19,228 |
| OR procedure for obesity w MCC | MS-DRG 619 | $34,040 |
| OR procedure for obesity w CC | MS-DRG 620 | $18,866 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $17,783 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $14,627 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $24,157 |
