| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $522.05 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,200.6 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,809.45 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,759.66 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,179.55 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $5,490.38 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,227.58 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $3,993.33 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,993.33 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,993.33 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,563.79 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $6,820.89 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $7,639.4 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $651.97 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $799.61 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $940.16 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,227.58 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,993.33 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,993.33 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $4,563.79 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $8,361.07 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $7,639.4 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $1,019.3 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,227.58 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,227.58 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,227.58 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $4,563.79 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $4,563.79 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $4,563.79 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $7,216.57 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $7,639.4 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $7,639.4 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,227.58 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,993.33 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $883.47 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $742.92 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $772.44 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $4,563.79 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $7,639.4 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,233.08 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $861.03 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $4,563.79 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,639.4 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,227.58 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,993.33 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,993.33 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,563.79 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $7,639.4 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $7,639.4 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,563.79 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $7,477.59 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,195.68 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,621.66 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,856.7 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,540.17 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,907.48 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,451.58 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,948.83 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,431.51 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $774.81 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,549.61 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $801.98 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $535.64 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,326 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,908.67 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $4,214.2 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $197.25 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $205.52 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $96.85 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $277.57 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $225.59 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $75.59 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $237.41 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $34.85 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $76.77 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $68.5 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $103.94 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $160.63 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $111.03 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $92.12 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $148.82 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $281.11 | — | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $5,199.82 | — | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $106.29 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $287.01 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $582.29 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $895.27 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,118.51 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $4,205.33 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $4,847.86 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,157.88 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $3,144.11 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $11,561 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $4,985.45 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,193.92 | — | — | — | — |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 0 | $25,426 | — | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $28,205 | — | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $28,187 | — | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $40,306 | — | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $47,499 | — | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $48,879 | — | — | — | — |