| behavioral |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $795 | $516.75 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $249 | $161.85 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $256 | $166.4 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $699 | $454.35 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,242 | $807.3 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $5,546 | $3,604.9 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,673 | $4,337.45 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,982 | $1,288.3 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,922 | $1,249.3 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,517 | $1,636.05 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,359 | $2,183.35 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $4,251 | $2,763.15 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,135 | $2,037.75 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,406 | $3,513.9 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $502 | $326.3 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $364 | $236.6 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $553 | $359.45 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,468 | $1,604.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,283 | $2,133.95 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,749 | $2,436.85 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,956 | $2,571.4 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,323 | $2,809.95 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $387 | $251.55 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,656 | $1,726.4 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,903 | $1,886.95 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,616 | $1,700.4 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,657 | $2,377.05 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,664 | $2,381.6 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,647 | $2,370.55 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,332 | $3,465.8 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,274 | $3,428.1 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,631 | $1,710.15 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,687 | $2,396.55 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $816 | $530.4 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $716 | $465.4 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $806 | $523.9 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,180 | $3,367 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,215 | $3,389.75 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $336 | $218.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $838 | $544.7 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $5,180 | $3,367 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,040 | $2,626 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,258 | $1,467.7 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,353 | $2,179.45 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,917 | $2,546.05 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,728 | $1,773.2 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,142 | $2,692.3 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,857 | $3,157.05 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,659 | $2,378.35 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,621 | $3,653.65 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,011 | $657.15 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $814 | $529.1 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $934 | $607.1 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $834 | $542.1 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,056 | $686.4 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $968 | $629.2 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $574 | $373.1 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $878 | $570.7 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $876 | $569.4 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $301 | $195.65 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $348 | $226.2 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $339 | $220.35 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $438 | $284.7 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $47 | $30.55 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,492 | $969.8 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $324 | $210.6 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $437 | $284.05 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $649 | $421.85 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $234 | $152.1 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $501 | $325.65 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $106 | $68.9 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $96 | $62.4 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $280 | $182 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $106 | $68.9 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $102 | $66.3 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $75 | $48.75 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $42 | $27.3 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $46 | $29.9 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $216 | $140.4 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $55 | $35.75 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $222 | $144.3 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $79 | $51.35 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $65 | $42.25 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $191 | $124.15 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $124 | $80.6 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $622 | $404.3 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $715 | $464.75 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $288 | $187.2 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $267 | $173.55 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $434 | $282.1 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $584 | $379.6 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $282 | $183.3 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $219 | $142.35 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $250 | $162.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $320 | $208 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $467 | $303.55 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,122 | $729.3 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,924 | $1,250.6 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,486 | $965.9 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,739 | $1,130.35 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,719 | $1,767.35 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,182 | $2,068.3 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,353 | $1,529.45 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $29,103 | $18,917 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $34,759 | $22,593 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $25,778 | $16,756 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $30,687 | $19,947 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $9,538 | $6,199.7 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $17,670 | $11,486 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $7,543 | $4,902.95 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $11,441 | $7,436.44 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $8,952 | $5,818.8 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $9,477 | $6,160.05 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $10,842 | $7,047.3 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $19,557 | $12,712 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $5,916.67 | $3,845.84 | — | — | — |