| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $339.52 | $271.62 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $247.67 | $198.14 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $330 | $264 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $349.03 | $279.22 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $420.2 | $336.16 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $375.63 | $300.5 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $665.12 | $532.1 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $980.32 | $784.26 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,781.01 | $1,424.81 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,580.49 | $2,064.39 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,201.36 | $2,561.09 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,674.1 | $2,139.28 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,824.91 | $2,259.93 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,045.13 | $2,436.1 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $3,142.34 | $2,513.87 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,503.89 | $2,803.11 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,981.45 | $3,185.16 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $5,134.09 | $4,107.27 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $625.96 | $500.77 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $347.99 | $278.39 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $375.16 | $300.13 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,595.85 | $2,876.68 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,770.36 | $3,016.29 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,428.65 | $2,742.92 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,950.1 | $3,160.08 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,858.7 | $3,886.96 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $635.46 | $508.37 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,903.09 | $3,122.47 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,905.73 | $3,124.58 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,863.28 | $3,090.62 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,442.9 | $3,554.32 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $5,027.5 | $4,022 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,119.46 | $4,095.57 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,597.02 | $2,877.62 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $539.09 | $431.27 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $534.28 | $427.42 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $494.51 | $395.61 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,592.83 | $2,874.26 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $5,249.74 | $4,199.79 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $438.28 | $350.62 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $473.69 | $378.95 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,471.47 | $2,777.18 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $5,488.78 | $4,391.02 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $3,394.16 | $2,715.33 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,531.06 | $2,824.85 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,971.41 | $3,177.13 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,509.29 | $2,807.43 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,912.12 | $4,729.7 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $6,606.33 | $5,285.06 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,639.42 | $2,911.54 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $5,152.4 | $4,121.92 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,334.07 | $1,067.26 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $990.63 | $792.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,437.7 | $1,150.16 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $919.6 | $735.68 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,015.74 | $812.59 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,314.5 | $1,051.6 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $730.46 | $584.37 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $992.74 | $794.19 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $913.36 | $730.69 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $635.8 | $508.64 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $877.8 | $702.24 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $733.7 | $586.96 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $349.6 | $279.68 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,568.28 | $2,054.62 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,843.38 | $1,474.7 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,719.2 | $2,175.36 | — | — | — |
| inpatient |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $209 | $167.2 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $284.9 | $227.92 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $393.97 | $315.18 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $376.2 | $300.96 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $817.19 | $653.75 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $428.45 | $342.76 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $311.41 | $249.13 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $332.31 | $265.85 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $82.56 | $66.05 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $150.48 | $120.38 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $355.3 | $284.24 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $147.86 | $118.29 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $147.4 | $117.92 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $210.05 | $168.04 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $131.1 | $104.88 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $730.46 | $584.37 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $850.3 | $680.24 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $2,071.3 | $1,657.04 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $4,330.48 | $3,464.38 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $2,610.3 | $2,088.24 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $253.94 | $203.15 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $356.35 | $285.08 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $447.26 | $357.81 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $562.21 | $449.77 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $192.5 | $154 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $236.17 | $188.94 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $284.24 | $227.39 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $365.75 | $292.6 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $449.35 | $359.48 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,810.67 | $2,248.54 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,713.94 | $2,171.15 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,256.4 | $1,805.12 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,512.07 | $2,009.66 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,992.88 | $2,394.3 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,429.37 | $2,743.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,022.14 | $2,417.71 | — | — | — |
| surgery |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $14,461 | $11,568 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $8,395.53 | $6,716.42 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $26,948 | $21,558 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $9,232.58 | $7,386.06 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $8,955.55 | $7,164.44 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $17,387 | $13,909 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $5,704.66 | $4,563.73 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $14,681 | $11,745 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $13,830 | $11,064 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $21,873 | $17,498 | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $10,953 | $8,762.62 | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $7,877.85 | $6,302.28 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $7,385.4 | $5,908.32 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $6,324.09 | $5,059.27 | — | — | — |
| PCI single major coronary artery | CPT | 92920 | 0 | $13,212 | $10,570 | — | — | — |
