| emergency |
| Critical care, first hour | CPT | 99291 | 0 | $531 | $531 | — | — | — |
| imaging |
| Chest X-ray single view | CPT | 71045 | 1 | $200 | $200 | $103.78 | $103.78 | $103.78 |
| Chest X-ray 2 views | CPT | 71046 | 0 | $200 | $200 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $200 | $200 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 7 | $375 | $375 | $11.91 | $118.6 | $124.68 |
| Shoulder X-ray | CPT | 73030 | 1 | $200 | $200 | $103.78 | $103.78 | $103.78 |
| Humerus X-ray | CPT | 73060 | 0 | $200 | $200 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $200 | $200 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 1 | $200 | $200 | $103.78 | $103.78 | $103.78 |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $200 | $200 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $280 | $280 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $280 | $280 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $112 | $112 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $280 | $280 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $280 | $280 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $45 | $45 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $138 | $138 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,204 | $1,204 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $583 | $583 | — | — | — |
| inpatient |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $46,596 | $46,596 | $46,596 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $26,566 | $26,566 | $26,566 |
| Heart failure & shock w MCC | MS-DRG | 291 | 3 | — | — | $1,650 | $39,740 | $39,740 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $38,622 | $38,622 | $38,622 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $41,107 | $41,107 | $41,107 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 3 | — | — | $420 | $1,830 | $41,940 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $28,050 | $28,050 | $28,050 |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $267 | $267 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $362 | $362 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $531 | $531 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $192 | $192 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $282 | $282 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $30 | $30 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $25 | $25 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $38 | $38 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $48 | $48 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $31 | $31 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $29 | $29 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $8 | $8 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $14 | $14 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $35 | $35 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $61 | $61 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $28 | $28 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $23 | $23 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $29 | $29 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $269 | $269 | — | — | — |
| office |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 1 | $550 | $550 | $58.12 | $108.45 | $158.78 |
