| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $249.78 | $149.87 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $654.68 | $392.81 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $238.96 | $143.38 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $299.73 | $179.84 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $359.73 | $215.84 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 1 | $1,098.28 | $658.97 | $370 | $370 | $370 |
| ED visit level 2 | CPT | 99282 | 1 | $1,925.14 | $1,155.08 | $740 | $740 | $740 |
| ED visit level 3 | CPT | 99283 | 1 | $3,494.12 | $2,096.47 | $1,730 | $1,730 | $1,730 |
| ED visit level 4 | CPT | 99284 | 1 | $6,509.13 | $3,905.48 | $3,830 | $3,830 | $3,830 |
| ED visit level 5 | CPT | 99285 | 1 | $8,592.58 | $5,155.55 | $5,410 | $5,410 | $5,410 |
| Critical care, first hour | CPT | 99291 | 1 | $12,285 | $7,371.25 | $7,500 | $7,500 | $7,500 |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $307.05 | $184.23 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,765.72 | $1,059.43 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $680.91 | $408.55 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $604.85 | $362.91 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $715.99 | $429.59 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,035.69 | $621.41 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,197.08 | $718.25 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $149.88 | $89.93 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $149.88 | $89.93 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $143.98 | $86.39 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $307.05 | $184.23 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $604.85 | $362.91 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $680.91 | $408.55 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $715.99 | $429.59 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,293.48 | $2,576.09 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,197.08 | $718.25 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $139.21 | $83.53 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $307.05 | $184.23 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $307.05 | $184.23 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $307.05 | $184.23 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $715.99 | $429.59 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $715.99 | $429.59 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $715.99 | $429.59 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,035.69 | $621.41 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,197.08 | $718.25 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,197.08 | $718.25 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $307.05 | $184.23 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $604.85 | $362.91 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,726.71 | $1,036.03 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $721.61 | $432.97 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $1,609.11 | $965.47 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $715.99 | $429.59 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,197.08 | $718.25 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $1,442.95 | $865.77 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,609.11 | $965.47 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,431.72 | $859.03 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $10,396 | $6,237.38 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $307.05 | $184.23 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $604.85 | $362.91 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $680.91 | $408.55 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $587.17 | $352.3 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $947.56 | $568.54 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $947.56 | $568.54 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $715.99 | $429.59 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,197.08 | $718.25 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $326.71 | $196.03 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $326.71 | $196.03 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $326.71 | $196.03 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $326.71 | $196.03 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $326.71 | $196.03 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $326.71 | $196.03 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $326.71 | $196.03 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $326.71 | $196.03 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $411.49 | $246.89 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $556.97 | $334.18 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $488.99 | $293.39 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $55.64 | $33.38 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $714.82 | $428.89 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $12,136 | $7,281.59 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $8,910.27 | $5,346.16 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $6,350.21 | $3,810.13 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $15,199 | $9,119.34 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $46,246 | $27,748 | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | $56,602 | $33,961 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $49,031 | $29,419 | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | $31,688 | $19,013 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $89.53 | $53.72 | — | — | — |
| General health panel | CPT | 80050 | 0 | $1,796.88 | $1,078.13 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $74.1 | $44.46 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $111.7 | $67.02 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $565.84 | $339.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $91.77 | $55.06 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $86.45 | $51.87 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $13.92 | $8.35 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $23.85 | $14.31 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $21.89 | $13.13 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $454.97 | $272.98 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $124.05 | $74.43 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $28.9 | $17.34 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $24.13 | $14.48 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $59.78 | $35.87 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $42.37 | $25.42 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $398.27 | $238.96 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,169.57 | $701.74 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $234.07 | $140.44 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $261.88 | $157.13 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $289.69 | $173.81 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $317.5 | $190.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $487.5 | $292.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $251.84 | $151.1 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $281.71 | $169.03 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $311.83 | $187.1 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $317.5 | $190.5 | — | — | — |
| surgery |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 0 | $22,752 | $13,651 | — | — | — |
| Major joint replacement w/o MCC | MS-DRG | 470 | 0 | $8,331.91 | $4,999.15 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $65,091 | $39,055 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $88,719 | $53,231 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $88,719 | $53,231 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $43,346 | $26,007 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $36,140 | $21,684 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $49,263 | $29,558 | — | — | — |
