| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $260.8 | $221.68 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $364.63 | $309.94 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $584.43 | $496.77 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $813.12 | $691.15 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,048.16 | $890.94 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,562.72 | $1,328.31 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,564.17 | $1,329.54 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,591.04 | $1,352.38 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,968.06 | $1,672.85 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,813.72 | $1,541.66 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,733.07 | $1,473.11 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,712.09 | $1,455.28 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,206.66 | $1,875.66 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $138.95 | $118.11 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $243.97 | $207.37 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $138.95 | $118.11 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,527.71 | $1,298.55 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,684.63 | $1,431.94 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $411.05 | $349.39 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,761.47 | $1,497.25 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,751.57 | $1,488.83 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,206.66 | $1,875.66 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $411.74 | $349.98 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,527.71 | $1,298.55 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,456.19 | $1,237.76 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $263.03 | $223.58 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,140.98 | $1,819.83 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,733.07 | $1,473.11 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,140.98 | $1,819.83 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,886.71 | $1,603.7 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,459.14 | $2,090.27 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,459.14 | $2,090.27 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,564.17 | $1,329.54 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,833.21 | $1,558.23 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $243.97 | $207.37 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $243.97 | $207.37 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $243.97 | $207.37 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,733.07 | $1,473.11 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,211.76 | $2,730 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $212.13 | $180.31 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $243.97 | $207.37 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,733.07 | $1,473.11 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,865.12 | $1,585.35 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,776.42 | $1,509.96 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,238.73 | $1,902.92 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,582.69 | $1,345.29 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,340.61 | $2,839.52 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $1,622.25 | $1,378.91 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,609.21 | $3,067.83 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,733.07 | $1,473.11 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,206.66 | $1,875.66 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $589.84 | $501.36 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $430.79 | $366.17 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $249.46 | $212.04 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $326.03 | $277.13 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $430.79 | $366.17 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $745.94 | $634.05 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $745.94 | $634.05 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $573.75 | $487.69 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $517.37 | $439.76 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $621.37 | $528.16 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $517.37 | $439.76 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $151.15 | $128.48 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,120.35 | $1,802.3 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $743.49 | $631.97 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,360.02 | $1,156.02 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $24,717 | $21,009 | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | $8,586.04 | $7,298.13 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $43,613 | $37,071 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $46,856 | $39,828 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $22,150 | $18,827 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $45,922 | $39,034 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $29,469 | $25,049 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $86,139 | $73,218 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $42,920 | $36,482 | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $253.63 | $215.59 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $344.24 | $292.6 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $509.54 | $433.11 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $52.5 | $44.63 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $72.66 | $61.76 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $105 | $89.25 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $90.81 | $77.19 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $163.39 | $138.88 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $108.91 | $92.57 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $48.48 | $41.21 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $36.25 | $30.81 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $33.03 | $28.08 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $117.38 | $99.77 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $114.36 | $97.21 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $37.72 | $32.06 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $31.93 | $27.14 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $125.03 | $106.28 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $179.2 | $152.32 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $308.09 | $261.88 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $4,131.07 | $3,511.41 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $4,131.07 | $3,511.41 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $128.66 | $109.36 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $192.92 | $163.98 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $330.02 | $280.52 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $431.08 | $366.42 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $23.63 | $20.09 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $65.68 | $55.83 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $130.94 | $111.3 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $201.68 | $171.43 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $284.9 | $242.17 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,765.44 | $2,350.62 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,903.71 | $2,468.15 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,424.74 | $2,061.03 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,661.34 | $1,412.14 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,424.74 | $2,061.03 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,204.65 | $2,723.95 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,204.65 | $2,723.95 | — | — | — |
| surgery |
| Total hip replacement | CPT | 27130 | 0 | $2,696.43 | $2,291.97 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $55,978 | $47,581 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $10,190 | $8,661.22 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $10,250 | $8,712.63 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $10,250 | $8,712.63 | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $7,198.86 | $6,119.03 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $10,250 | $8,712.63 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $9,201.86 | $7,821.58 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $20,507 | $17,431 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $10,250 | $8,712.63 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $13,272 | $11,281 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $13,694 | $11,640 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $22,743 | $19,331 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $13,966 | $11,872 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $9,979.6 | $8,482.66 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $15,916 | $13,529 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $15,269 | $12,978 | — | — | — |
