| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $633 | $234.21 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $697 | $257.89 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,107 | $409.59 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,926 | $712.62 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,119 | $784.03 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,071 | $396.27 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,038 | $754.06 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,733 | $641.21 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,647 | $979.39 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,034 | $1,122.58 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $151 | $55.87 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $208 | $76.96 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,730 | $640.1 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,288 | $846.56 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,730 | $640.1 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,730 | $640.1 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,730 | $640.1 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,651 | $980.87 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,648 | $979.76 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,118 | $783.66 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,796 | $1,404.52 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,796 | $1,404.52 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,734 | $641.58 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,526 | $564.62 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $390 | $144.3 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $390 | $144.3 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $368 | $136.16 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,280 | $1,953.6 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $7,550 | $2,793.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $354 | $130.98 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $374 | $138.38 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,550 | $2,793.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,734 | $641.58 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,287 | $846.19 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,601 | $962.37 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,288 | $846.56 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,064 | $1,503.68 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,778 | $1,397.86 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $490 | $181.3 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $545 | $201.65 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $732 | $270.84 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $612 | $226.44 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $468 | $173.16 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | — | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | — | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | — | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | — | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | — | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $64,125 | $23,726 | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | — | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | — | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | — | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | — | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | — | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | — | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $46,322 | $17,139 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $61 | $22.57 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $36 | $13.32 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $66 | $24.42 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $67 | $24.79 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $58 | $21.46 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $42 | $15.54 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $13 | $4.81 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $27 | $9.99 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $61 | $22.57 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $124 | $45.88 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $48 | $17.76 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $38 | $14.06 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $54 | $19.98 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $46 | $17.02 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $257 | $95.09 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,890 | $1,069.3 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,890 | $1,069.3 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,025 | $749.25 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,025 | $749.25 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,067 | $1,134.79 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,067 | $1,134.79 | — | — | — |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | — | — | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | — | — | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | — | — | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | — | — | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | — | — | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | — | — | — | — | — |
| OR procedure for obesity w MCC | MS-DRG | 619 | 0 | — | — | — | — | — |
| OR procedure for obesity w CC | MS-DRG | 620 | 0 | — | — | — | — | — |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | — | — | — | — | — |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 0 | — | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $21,189 | $7,839.93 | — | — | — |