| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $255 | $191.25 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $501 | $375.75 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,075 | $806.25 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,836 | $1,377 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,380 | $2,535 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,236 | $3,177 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,871 | $1,403.25 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,290 | $1,717.5 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,799 | $2,099.25 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,977 | $1,482.75 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,221 | $915.75 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,321 | $990.75 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,552 | $1,164 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $254 | $190.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $315 | $236.25 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $391 | $293.25 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,801 | $1,350.75 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,114 | $1,585.5 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,587 | $1,940.25 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,162 | $871.5 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,211 | $908.25 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,528 | $1,146 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $419 | $314.25 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,339 | $1,754.25 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,339 | $1,754.25 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,339 | $1,754.25 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,220 | $915 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,231 | $923.25 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,219 | $914.25 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,286 | $964.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,560 | $1,170 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,566 | $1,174.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,660 | $1,995 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,277 | $1,707.75 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $364 | $273 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $355 | $266.25 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $324 | $243 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,190 | $892.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,475 | $1,106.25 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $261 | $195.75 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $314 | $235.5 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,185 | $888.75 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,506 | $1,129.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,783 | $1,337.25 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,158 | $1,618.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,675 | $2,006.25 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,814 | $2,860.5 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,356 | $3,267 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,341 | $4,005.75 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,242 | $931.5 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,541 | $1,155.75 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $778 | $583.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $581 | $435.75 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $814 | $610.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $922 | $691.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $860 | $645 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $933 | $699.75 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $640 | $480 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $627 | $470.25 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $583 | $437.25 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $462 | $346.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $572 | $429 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $532 | $399 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $301 | $225.75 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,540 | $2,655 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,808 | $2,106 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $319 | $239.25 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $525 | $393.75 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $730 | $547.5 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $243 | $182.25 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $350 | $262.5 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $209 | $156.75 | — | — | — |
| General health panel | CPT | 80050 | 0 | $181 | $135.75 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $114 | $85.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $350 | $262.5 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $121 | $90.75 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $268 | $201 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $204 | $153 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $49 | $36.75 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $233 | $174.75 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $84 | $63 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $144 | $108 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $196 | $147 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $163 | $122.25 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $97 | $72.75 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $287 | $215.25 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $454 | $340.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $6,082 | $4,561.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $382 | $286.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $577 | $432.75 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $825 | $618.75 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $892 | $669 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $114 | $85.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $329 | $246.75 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $491 | $368.25 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $686 | $514.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $949 | $711.75 | — | — | — |
| preventive |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,212 | $909 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,663 | $1,247.25 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,181 | $1,635.75 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,909 | $1,431.75 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,332 | $2,499 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,214 | $3,910.5 | — | — | — |
| surgery |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 0 | $25,560 | $19,170 | — | — | — |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 0 | $22,561 | $16,921 | — | — | — |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 0 | $36,450 | $27,338 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 0 | $14,040 | $10,530 | — | — | — |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 0 | $19,800 | $14,850 | — | — | — |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 0 | $50,246 | $37,685 | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | $42,702 | $32,027 | — | — | — |
| Major joint replacement w MCC | MS-DRG | 469 | 0 | $37,707 | $28,281 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $20,288 | $15,216 | — | — | — |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 0 | $25,110 | $18,833 | — | — | — |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 0 | $25,192 | $18,894 | — | — | — |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 0 | $43,222 | $32,416 | — | — | — |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 0 | $23,220 | $17,415 | — | — | — |