| Critical care, first hour | CPT 99291 | $3,349.97 |
| CT head without contrast | CPT 70450 | $1,871.1 |
| CT head with contrast | CPT 70460 | $2,964.75 |
| CT head with and without contrast | CPT 70470 | $3,550.23 |
| CT neck with contrast | CPT 70491 | $1,916.46 |
| MRI brain with and without contrast | CPT 70553 | $3,797.28 |
| Chest X-ray single view | CPT 71045 | $273.52 |
| Chest X-ray 2 views | CPT 71046 | $222.75 |
| Chest X-ray 3 views | CPT 71047 | $400.67 |
| CT chest without contrast | CPT 71250 | $1,871.1 |
| CT chest with contrast | CPT 71260 | $3,201.93 |
| CT chest with and without contrast | CPT 71270 | $2,158.65 |
| Lumbosacral spine X-ray | CPT 72100 | $353.77 |
| CT cervical spine without contrast | CPT 72125 | $973.62 |
| CT thoracic spine without contrast | CPT 72128 | $1,469.34 |
| CT lumbar spine without contrast | CPT 72131 | $973.62 |
| MRI cervical spine without contrast | CPT 72141 | $2,270.43 |
| MRI thoracic spine without contrast | CPT 72146 | $5,493 |
| MRI lumbar spine without contrast | CPT 72148 | $5,493 |
| MRI lumbar spine with and without contrast | CPT 72149 | $5,493 |
| MRI cervical spine with and without contrast | CPT 72156 | $8,532.86 |
| MRI lumbar spine with contrast | CPT 72158 | $8,532.86 |
| CT pelvis without contrast | CPT 72192 | $1,871.1 |
| CT pelvis with contrast | CPT 72193 | $3,201.93 |
| Shoulder X-ray | CPT 73030 | $353.77 |
| Humerus X-ray | CPT 73060 | $279.45 |
| Hand X-ray 3 views | CPT 73130 | $337.16 |
| Knee X-ray 1-2 views | CPT 73560 | $337.16 |
| Ankle X-ray 3 views | CPT 73610 | $347.9 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,270.43 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,310.21 |
| CT abdomen without contrast | CPT 74150 | $1,871.1 |
| CT abdomen with contrast | CPT 74160 | $3,201.93 |
| CT abdomen with and without contrast | CPT 74170 | $5,346.41 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,298.32 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,201.82 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $8,019.53 |
| MRI abdomen without contrast | CPT 74181 | $5,493 |
| MRI abdomen with and without contrast | CPT 74183 | $8,399.55 |
| Abdominal ultrasound complete | CPT 76700 | $1,435.6 |
| Abdominal ultrasound limited | CPT 76705 | $852.79 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,285.1 |
| Transvaginal ultrasound | CPT 76830 | $576.86 |
| Pelvic ultrasound complete | CPT 76856 | $1,281.19 |
| Scrotal ultrasound | CPT 76870 | $1,329.08 |
| EKG tracing only | CPT 93005 | $135.98 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,317.31 |
| Transthoracic echocardiogram | CPT 93307 | $742.5 |
| Stress echocardiogram | CPT 93350 | $2,526.39 |
| Intracranial hemorrhage/CVA w MCC | MS-DRG 064 | $68,477 |
| Intracranial hemorrhage/CVA w CC | MS-DRG 065 | $35,876 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG 066 | $25,163 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $42,672 |
| COPD w MCC | MS-DRG 190 | $34,402 |
| COPD w CC | MS-DRG 191 | $34,402 |
| COPD w/o CC/MCC | MS-DRG 192 | $34,402 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $28,079 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $25,163 |
| AMI discharged alive w MCC | MS-DRG 280 | $43,161 |
| AMI discharged alive w CC | MS-DRG 281 | $33,622 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $25,163 |
| Heart failure & shock w MCC | MS-DRG 291 | $40,508 |
| Heart failure & shock w CC | MS-DRG 292 | $28,764 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $25,163 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $44,072 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $25,163 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $25,163 |
| GI hemorrhage w CC | MS-DRG 378 | $33,622 |
| GI hemorrhage w/o CC/MCC | MS-DRG 379 | $33,622 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $32,975 |
| Fractures of femur w/o MCC | MS-DRG 533 | $38,187 |
| Kidney/UTI w MCC | MS-DRG 689 | $33,259 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $24,742 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $44,688 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $29,943 |
| Basic metabolic panel (BMP) | CPT 80048 | $25.37 |
| Electrolyte panel | CPT 80051 | $53.57 |
| Comprehensive metabolic panel | CPT 80053 | $81.23 |
| Lipid panel | CPT 80061 | $407.06 |
| Renal function panel | CPT 80069 | $90.36 |
| Hepatic function panel | CPT 80076 | $50.89 |
| Urinalysis automated | CPT 81003 | $25.11 |
| Glucose quantitative | CPT 82947 | $25 |
| Hemoglobin A1c | CPT 83036 | $101.77 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $152.66 |
| Complete blood count with automated differential | CPT 85025 | $23.3 |
| Complete blood count without differential | CPT 85027 | $19.4 |
| Urine culture bacterial | CPT 87086 | $87.48 |
| Urine culture identification | CPT 87088 | $61.59 |
| Tissue exam by pathologist level IV | CPT 88305 | $229.23 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,108.08 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,108.08 |
| Sigmoidoscopy diagnostic | CPT 45330 | $763.02 |
| Sigmoidoscopy with biopsy | CPT 45331 | $763.02 |
| Colonoscopy diagnostic | CPT 45378 | $1,218.24 |
| Colonoscopy with biopsy | CPT 45380 | $1,218.24 |
| Colonoscopy with polyp removal | CPT 45385 | $1,218.24 |
| Major small/large bowel procedures w MCC | MS-DRG 329 | $66,450 |
| Major small/large bowel procedures w CC | MS-DRG 330 | $33,622 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG 331 | $33,622 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG 418 | $38,187 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG 419 | $38,187 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG 420 | $37,855 |
| Major joint replacement w MCC | MS-DRG 469 | $66,450 |
| Major joint replacement w/o MCC | MS-DRG 470 | $35,876 |
| Hip & femur procedures except major joint w MCC | MS-DRG 480 | $35,876 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $35,876 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG 482 | $35,876 |
| OR procedure for obesity w MCC | MS-DRG 619 | $68,835 |
| OR procedure for obesity w CC | MS-DRG 620 | $49,941 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $35,876 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $66,450 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG 744 | $66,450 |
