| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $420.8 | $210.4 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $469.1 | $234.55 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $114 | $57 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $214.4 | $107.2 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $335.1 | $167.55 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $337.7 | $168.85 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $436.2 | $218.1 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $534.9 | $267.45 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $837.3 | $418.65 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,125.7 | $562.85 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,919.3 | $959.65 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,143.3 | $1,071.65 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,392.1 | $1,196.05 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,029.6 | $1,514.8 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,824.2 | $1,412.1 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,318 | $1,659 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,358.8 | $1,679.4 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,551.9 | $2,275.95 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $443.2 | $221.6 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $506.5 | $253.25 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $787.9 | $393.95 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,040.2 | $1,020.1 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,392.1 | $1,196.05 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,884.6 | $1,442.3 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,884.6 | $1,442.3 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $3,198.4 | $1,599.2 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,865.4 | $1,932.7 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $456 | $228 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,546.9 | $1,273.45 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,143.3 | $1,071.65 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,236 | $1,118 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,424.9 | $1,712.45 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,055.1 | $1,527.55 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,517.7 | $1,758.85 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,940 | $1,970 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,865.4 | $1,932.7 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,502.7 | $2,251.35 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,268.3 | $1,134.15 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,638.4 | $1,319.2 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $443.2 | $221.6 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $443.2 | $221.6 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $443.2 | $221.6 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,287 | $1,643.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,058 | $2,029 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $410.8 | $205.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $443.2 | $221.6 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,341.9 | $1,670.95 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,370.5 | $2,185.25 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,341.4 | $1,170.7 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,025.3 | $1,512.65 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,517.7 | $1,758.85 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,937.2 | $1,968.6 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,065.6 | $2,532.8 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,514.5 | $2,757.25 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,517.7 | $1,758.85 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,502.7 | $2,251.35 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,259.4 | $629.7 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,161 | $580.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,161 | $580.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $868.2 | $434.1 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,055.4 | $527.7 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $886.5 | $443.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,090.6 | $545.3 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,161 | $580.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $541.8 | $270.9 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $790.9 | $395.45 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $790.9 | $395.45 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $354.6 | $177.3 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,095.6 | $1,547.8 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | — | — | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | — | — | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | — | — | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | — | — | — | — | — |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 0 | — | — | — | — | — |
| AMI discharged alive w MCC | MS-DRG | 280 | 0 | — | — | — | — | — |
| AMI discharged alive w CC | MS-DRG | 281 | 0 | — | — | — | — | — |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 0 | — | — | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | — | — | — | — | — |
| Heart failure & shock w CC | MS-DRG | 292 | 0 | — | — | — | — | — |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 0 | — | — | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | — | — | — | — | — |
| GI hemorrhage w CC | MS-DRG | 378 | 0 | — | — | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | — | — | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | — | — | — | — | — |
| Fractures of femur w/o MCC | MS-DRG | 533 | 0 | — | — | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | — | — | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | — | — | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $253.3 | $126.65 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $160.4 | $80.2 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $309.5 | $154.75 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $295.6 | $147.8 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $247.6 | $123.8 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $288.6 | $144.3 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $28.2 | $14.1 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $49.1 | $24.55 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $112.6 | $56.3 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $176 | $88 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $193.6 | $96.8 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $170.4 | $85.2 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $125.4 | $62.7 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $140.8 | $70.4 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $119.7 | $59.85 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $387 | $193.5 | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $6,533 | $3,266.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $176 | $88 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $246.3 | $123.15 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $316.7 | $158.35 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $387 | $193.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $70.4 | $35.2 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $140.8 | $70.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $211.2 | $105.6 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $281.5 | $140.75 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $436 | $218 | — | — | — |
