| emergency |
| Critical care, first hour | CPT | 99291 | 10 | $4,466.63 | $4,466.63 | $3,126.64 | $3,349.97 | 3.1× | $4,019.97 |
| imaging |
| CT head without contrast | CPT | 70450 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 13.4× | $3,337.61 |
| CT head with contrast | CPT | 70460 | 10 | $5,729.75 | $5,729.75 | $4,010.83 | $4,297.31 | 18.4× | $5,156.78 |
| CT head with and without contrast | CPT | 70470 | 10 | $6,382.3 | $6,382.3 | $4,467.61 | $4,786.73 | 17.9× | $5,744.07 |
| MRI brain without contrast | CPT | 70551 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 12.2× | $5,901.62 |
| MRI brain with and without contrast | CPT | 70553 | 10 | $3,961.34 | $3,961.34 | $2,772.94 | $2,971.01 | 5.0× | $3,565.21 |
| Chest X-ray single view | CPT | 71045 | 10 | $320.85 | $320.85 | $224.6 | $240.64 | 2.5× | $288.77 |
| Chest X-ray 2 views | CPT | 71046 | 10 | $571.75 | $571.75 | $400.23 | $428.81 | 4.4× | $514.58 |
| CT chest without contrast | CPT | 71250 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 12.9× | $3,337.61 |
| CT chest with contrast | CPT | 71260 | 10 | $5,729.75 | $5,729.75 | $4,010.83 | $4,297.31 | 15.3× | $5,156.78 |
| CT chest with and without contrast | CPT | 71270 | 10 | $6,382.3 | $6,382.3 | $4,467.61 | $4,786.73 | 16.4× | $5,744.07 |
| Lumbosacral spine X-ray | CPT | 72100 | 10 | $517.45 | $517.45 | $362.22 | $388.09 | 3.8× | $465.71 |
| CT cervical spine without contrast | CPT | 72125 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 13.8× | $3,337.61 |
| CT thoracic spine without contrast | CPT | 72128 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 14.0× | $3,337.61 |
| CT lumbar spine without contrast | CPT | 72131 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 13.7× | $3,337.61 |
| MRI thoracic spine without contrast | CPT | 72146 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 13.2× | $5,901.62 |
| MRI lumbar spine without contrast | CPT | 72148 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 13.1× | $5,901.62 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 10.8× | $5,901.62 |
| MRI cervical spine with and without contrast | CPT | 72156 | 10 | $10,186 | $10,186 | $7,130.31 | $7,639.61 | 14.1× | $9,167.54 |
| MRI lumbar spine with contrast | CPT | 72158 | 10 | $10,186 | $10,186 | $7,130.31 | $7,639.61 | 14.0× | $9,167.54 |
| CT pelvis without contrast | CPT | 72192 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 13.9× | $3,337.61 |
| CT pelvis with contrast | CPT | 72193 | 10 | $5,729.75 | $5,729.75 | $4,010.83 | $4,297.31 | 15.3× | $5,156.78 |
| Shoulder X-ray | CPT | 73030 | 10 | $762.75 | $762.75 | $296.31 | $457.45 | 4.9× | $686.48 |
| Humerus X-ray | CPT | 73060 | 10 | $384.65 | $384.65 | $269.26 | $288.49 | 3.2× | $346.19 |
| Knee X-ray 1-2 views | CPT | 73560 | 10 | $380.4 | $380.4 | $230.44 | $282.56 | 3.0× | $342.36 |
| MRI lower extremity joint without contrast | CPT | 73721 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 10.5× | $5,901.62 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 7.8× | $5,901.62 |
| CT abdomen without contrast | CPT | 74150 | 10 | $3,708.45 | $3,708.45 | $2,595.92 | $2,781.34 | 14.8× | $3,337.61 |
| CT abdomen with contrast | CPT | 74160 | 10 | $5,729.75 | $5,729.75 | $4,010.83 | $4,297.31 | 15.0× | $5,156.78 |
| CT abdomen with and without contrast | CPT | 74170 | 10 | $6,382.3 | $6,382.3 | $4,467.61 | $4,786.73 | 14.3× | $5,744.07 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 10 | $5,562.65 | $5,562.65 | $3,893.86 | $4,171.99 | 11.5× | $5,006.39 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 10 | $8,594.55 | $8,594.55 | $6,016.19 | $6,445.91 | 11.7× | $7,735.1 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 10 | $9,573.4 | $9,573.4 | $6,701.38 | $7,180.05 | 12.5× | $8,616.06 |
| MRI abdomen without contrast | CPT | 74181 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 12.6× | $5,901.62 |
| MRI abdomen with and without contrast | CPT | 74183 | 10 | $6,557.35 | $6,557.35 | $4,590.15 | $4,918.01 | 8.7× | $5,901.62 |
| Abdominal ultrasound complete | CPT | 76700 | 10 | $1,176 | $1,176 | $823.2 | $882 | 5.9× | $1,058.4 |
| Abdominal ultrasound limited | CPT | 76705 | 10 | $1,018.05 | $1,018.05 | $712.64 | $763.54 | 5.2× | $916.25 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 10 | $1,415.51 | $1,415.51 | $743.19 | $973.2 | 6.8× | $1,273.96 |
| Transvaginal ultrasound | CPT | 76830 | 10 | $688.65 | $688.65 | $482.06 | $516.49 | 3.5× | $619.79 |
| Pelvic ultrasound complete | CPT | 76856 | 10 | $1,176 | $1,176 | $823.2 | $882 | 6.2× | $1,058.4 |
| Scrotal ultrasound | CPT | 76870 | 10 | $464.7 | $464.7 | $325.29 | $348.53 | 2.7× | $418.23 |
| EKG tracing only | CPT | 93005 | 10 | $363 | $363 | $254.1 | $272.25 | 2.3× | $326.7 |
| Transthoracic echocardiogram complete | CPT | 93306 | 10 | $1,106.25 | $1,106.25 | $774.38 | $829.69 | 1.4× | $995.63 |
| Transthoracic echocardiogram | CPT | 93307 | 10 | $1,106.25 | $1,106.25 | $774.38 | $829.69 | 3.4× | $995.63 |
| inpatient |
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 10 | — | — | $55,997 | $60,702 | 3.0× | $91,053 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 10 | — | — | $29,337 | $31,802 | 3.0× | $47,704 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 10 | — | — | $20,577 | $22,306 | 2.9× | $33,459 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 10 | — | — | $34,895 | $37,827 | 2.5× | $56,740 |
| COPD w MCC | MS-DRG | 190 | 10 | — | — | $28,132 | $30,496 | 2.7× | $45,744 |
| COPD w CC | MS-DRG | 191 | 10 | — | — | $28,132 | $30,496 | 3.5× | $45,744 |
| COPD w/o CC/MCC | MS-DRG | 192 | 10 | — | — | $28,132 | $30,496 | 4.4× | $45,744 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 10 | — | — | $22,962 | $24,891 | 2.9× | $37,337 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 10 | — | — | $20,577 | $22,306 | 3.3× | $33,459 |
| AMI discharged alive w MCC | MS-DRG | 280 | 10 | — | — | $35,295 | $38,261 | 2.4× | $57,391 |
| AMI discharged alive w CC | MS-DRG | 281 | 10 | — | — | $27,495 | $29,805 | 3.1× | $44,708 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 10 | — | — | $20,577 | $22,306 | 2.9× | $33,459 |
| Heart failure & shock w MCC | MS-DRG | 291 | 10 | — | — | $33,126 | $35,909 | 2.8× | $53,863 |
| Heart failure & shock w CC | MS-DRG | 292 | 10 | — | — | $23,521 | $25,498 | 2.9× | $38,247 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 10 | — | — | $20,577 | $22,306 | 3.6× | $33,459 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 10 | — | — | $36,040 | $39,068 | 3.2× | $58,602 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 10 | — | — | $20,577 | $22,306 | 2.9× | $33,459 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 10 | — | — | $20,577 | $22,306 | 3.6× | $33,459 |
| GI hemorrhage w CC | MS-DRG | 378 | 10 | — | — | $27,495 | $29,805 | 3.0× | $44,708 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 10 | — | — | $27,495 | $29,805 | 4.4× | $44,708 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 10 | — | — | $26,965 | $29,231 | 3.6× | $43,847 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 10 | — | — | $31,227 | $33,851 | 2.2× | $50,777 |
| Kidney/UTI w MCC | MS-DRG | 689 | 10 | — | — | $27,198 | $29,483 | 2.5× | $44,225 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 10 | — | — | $20,233 | $21,933 | 2.6× | $32,899 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 10 | — | — | $36,544 | $39,614 | 2.1× | $59,421 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 10 | — | — | $24,486 | $26,543 | 2.6× | $39,815 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 10 | $467.2 | $467.2 | $327.04 | $350.4 | 10.8× | $420.48 |
| Electrolyte panel | CPT | 80051 | 10 | $296.15 | $296.15 | $207.31 | $222.11 | 9.3× | $266.54 |
| Comprehensive metabolic panel | CPT | 80053 | 10 | $609.35 | $609.35 | $426.55 | $457.01 | 10.3× | $548.42 |
| Lipid panel | CPT | 80061 | 10 | $243.75 | $243.75 | $170.63 | $182.81 | 4.8× | $219.38 |
| Renal function panel | CPT | 80069 | 10 | $595.35 | $595.35 | $416.75 | $446.51 | 16.4× | $535.82 |
| Hepatic function panel | CPT | 80076 | 10 | $390.25 | $390.25 | $273.18 | $292.69 | 11.0× | $351.23 |
| Urinalysis automated | CPT | 81003 | 10 | $81.55 | $81.55 | $57.09 | $61.16 | 4.4× | $73.4 |
| Hemoglobin A1c | CPT | 83036 | 10 | $153.05 | $153.05 | $107.14 | $114.79 | 4.3× | $137.75 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 10 | $228.6 | $228.6 | $160.02 | $171.45 | 3.6× | $205.74 |
| Complete blood count with automated differential | CPT | 85025 | 10 | $141.1 | $141.1 | $98.77 | $105.83 | 4.0× | $126.99 |
| Complete blood count without differential | CPT | 85027 | 10 | $145.25 | $145.25 | $101.68 | $108.94 | 5.0× | $130.73 |
| Urine culture bacterial | CPT | 87086 | 10 | $240.3 | $240.3 | $168.21 | $180.23 | 7.7× | $216.27 |
| Urine culture identification | CPT | 87088 | 10 | $294.6 | $294.6 | $206.22 | $220.95 | 9.9× | $265.14 |
| Tissue exam by pathologist level IV | CPT | 88305 | 10 | $510.4 | $510.4 | $357.28 | $382.8 | 3.7× | $459.36 |
| preventive |
| Upper GI endoscopy with biopsy | CPT | 43239 | 10 | $2,503.44 | $2,503.44 | $1,752.41 | $1,877.58 | 1.9× | $2,253.1 |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 10 | — | — | $54,340 | $58,906 | 1.4× | $88,359 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 10 | — | — | $27,495 | $29,805 | 1.3× | $44,708 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 10 | — | — | $27,495 | $29,805 | 1.8× | $44,708 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 10 | — | — | $31,227 | $33,851 | 2.1× | $50,777 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 10 | — | — | $31,227 | $33,851 | 2.5× | $50,777 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 10 | — | — | $30,956 | $33,557 | 1.0× | $50,336 |
| Major joint replacement w MCC | MS-DRG | 469 | 10 | — | — | $54,340 | $58,906 | 2.0× | $88,359 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 10 | — | — | $29,337 | $31,802 | 1.7× | $47,704 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 10 | — | — | $29,337 | $31,802 | 1.1× | $47,704 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 10 | — | — | $29,337 | $31,802 | 1.6× | $47,704 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 10 | — | — | $29,337 | $31,802 | 2.0× | $47,704 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 10 | — | — | $56,290 | $61,020 | 2.2× | $91,529 |
| OR procedure for obesity w CC | MS-DRG | 620 | 10 | — | — | $40,840 | $44,271 | 2.7× | $66,407 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 10 | — | — | $29,337 | $31,802 | 2.1× | $47,704 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 10 | — | — | $54,340 | $58,906 | 4.8× | $88,359 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 10 | — | — | $54,340 | $58,906 | 3.1× | $88,359 |