| ED visit level 1 | CPT 99281 | $272.43 |
| ED visit level 2 | CPT 99282 | $407.2 |
| ED visit level 3 | CPT 99283 | $683.76 |
| ED visit level 4 | CPT 99284 | $1,297.76 |
| ED visit level 5 | CPT 99285 | $1,122.43 |
| Critical care, first hour | CPT 99291 | $2,801.14 |
| CT head without contrast | CPT 70450 | $1,182.08 |
| CT head with contrast | CPT 70460 | $1,509.69 |
| CT head with and without contrast | CPT 70470 | $1,850.66 |
| CT neck with contrast | CPT 70491 | $1,491.21 |
| MRI brain without contrast | CPT 70551 | $1,168.47 |
| MRI brain with contrast | CPT 70552 | $1,761.68 |
| MRI brain with and without contrast | CPT 70553 | $1,822.19 |
| Chest X-ray single view | CPT 71045 | $204.15 |
| Chest X-ray 2 views | CPT 71046 | $207.92 |
| Chest X-ray 3 views | CPT 71047 | $224.25 |
| CT chest without contrast | CPT 71250 | $1,285.68 |
| CT chest with contrast | CPT 71260 | $1,509.18 |
| CT chest with and without contrast | CPT 71270 | $2,014.98 |
| MRI chest without contrast | CPT 71550 | $2,135.65 |
| MRI chest with and without contrast | CPT 71552 | $2,916.17 |
| Lumbosacral spine X-ray | CPT 72100 | $515.31 |
| CT cervical spine without contrast | CPT 72125 | $1,473.23 |
| CT thoracic spine without contrast | CPT 72128 | $1,063.46 |
| CT lumbar spine without contrast | CPT 72131 | $1,506.1 |
| MRI cervical spine without contrast | CPT 72141 | $1,980.57 |
| MRI thoracic spine without contrast | CPT 72146 | $1,802.39 |
| MRI lumbar spine without contrast | CPT 72148 | $1,846.04 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,764.53 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,311.05 |
| MRI lumbar spine with contrast | CPT 72158 | $3,300.78 |
| CT pelvis without contrast | CPT 72192 | $1,027.52 |
| CT pelvis with contrast | CPT 72193 | $2,180.84 |
| Shoulder X-ray | CPT 73030 | $528.25 |
| Humerus X-ray | CPT 73060 | $307.57 |
| Hand X-ray 3 views | CPT 73130 | $570.59 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,106.96 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,340.58 |
| Knee X-ray 1-2 views | CPT 73560 | $216.03 |
| Ankle X-ray 3 views | CPT 73610 | $448.61 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,996.89 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,544.24 |
| CT abdomen without contrast | CPT 74150 | $1,167.19 |
| CT abdomen with contrast | CPT 74160 | $1,686.85 |
| CT abdomen with and without contrast | CPT 74170 | $1,809.06 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,661.18 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,207.41 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,160.08 |
| MRI abdomen without contrast | CPT 74181 | $1,669.39 |
| MRI abdomen with and without contrast | CPT 74183 | $2,918.74 |
| Abdominal ultrasound complete | CPT 76700 | $1,248.32 |
| Abdominal ultrasound limited | CPT 76705 | $1,494.4 |
| Retroperitoneal ultrasound complete | CPT 76770 | $579.23 |
| Obstetric ultrasound first trimester | CPT 76801 | $486.99 |
| Obstetric ultrasound after first trimester | CPT 76805 | $593.1 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $690.97 |
| Transvaginal ultrasound | CPT 76830 | $898.19 |
| Pelvic ultrasound complete | CPT 76856 | $1,049.6 |
| Scrotal ultrasound | CPT 76870 | $948.75 |
| Diagnostic mammography unilateral | CPT 77065 | $359.15 |
| Diagnostic mammography bilateral | CPT 77066 | $526.44 |
| Screening mammography bilateral | CPT 77067 | $407.03 |
| EKG tracing only | CPT 93005 | $167.14 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,573.75 |
| Transthoracic echocardiogram | CPT 93307 | $1,275.02 |
| Stress echocardiogram | CPT 93350 | $2,471.11 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $20,755 |
| COPD w MCC | MS-DRG 190 | $19,038 |
| COPD w CC | MS-DRG 191 | $16,760 |
| COPD w/o CC/MCC | MS-DRG 192 | $9,000.99 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $19,053 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG 195 | $15,532 |
| AMI discharged alive w MCC | MS-DRG 280 | $18,265 |
| AMI discharged alive w CC | MS-DRG 281 | $14,989 |
| AMI discharged alive w/o CC/MCC | MS-DRG 282 | $16,365 |
| Heart failure & shock w MCC | MS-DRG 291 | $19,470 |
| Heart failure & shock w CC | MS-DRG 292 | $18,512 |
| Cardiac arrhythmia w MCC | MS-DRG 308 | $21,430 |
| Cardiac arrhythmia w CC | MS-DRG 309 | $14,732 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG 310 | $14,651 |
| GI hemorrhage w CC | MS-DRG 378 | $18,973 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG 392 | $11,862 |
| Kidney/UTI w MCC | MS-DRG 689 | $12,743 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $12,638 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $26,990 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG 872 | $20,812 |
| Basic metabolic panel (BMP) | CPT 80048 | $233.05 |
| General health panel | CPT 80050 | $603.48 |
| Electrolyte panel | CPT 80051 | $175.91 |
| Comprehensive metabolic panel | CPT 80053 | $312.66 |
| Lipid panel | CPT 80061 | $138.03 |
| Renal function panel | CPT 80069 | $165.64 |
| Hepatic function panel | CPT 80076 | $73.19 |
| Urinalysis automated | CPT 81003 | $44.94 |
| Glucose quantitative | CPT 82947 | $57.14 |
| Hemoglobin A1c | CPT 83036 | $143.81 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $179.12 |
| Complete blood count with automated differential | CPT 85025 | $93.73 |
| Complete blood count without differential | CPT 85027 | $93.73 |
| Urine culture bacterial | CPT 87086 | $103.36 |
| Urine culture identification | CPT 87088 | $72.55 |
| Tissue exam by pathologist level IV | CPT 88305 | $289.62 |
| Office visit, new patient, 15-29 min | CPT 99202 | $154.92 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $216.25 |
| Office visit, established patient, 5 min | CPT 99211 | $84.1 |
| Office visit, established patient, 10-19 min | CPT 99212 | $117.95 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $162 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $192.6 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,863.71 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,863.71 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,812.11 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,812.11 |
| Colonoscopy diagnostic | CPT 45378 | $1,812.11 |
| Colonoscopy with biopsy | CPT 45380 | $2,343.79 |
| Colonoscopy with polyp removal | CPT 45385 | $2,343.79 |
| Major joint replacement w/o MCC | MS-DRG 470 | $54,865 |
| Hip & femur procedures except major joint w CC | MS-DRG 481 | $40,628 |
