| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $258 | $206.4 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $379 | $303.2 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $703 | $562.4 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $973 | $778.4 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,352 | $1,081.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,785 | $1,428 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,380 | $1,904 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,650 | $2,120 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,569 | $2,055.2 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,623 | $2,898.4 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,686 | $2,948.8 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,326 | $3,460.8 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $237 | $189.6 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $368 | $294.4 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,704 | $2,163.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,245 | $2,596 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,461 | $2,768.8 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $5,138 | $4,110.4 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $551 | $440.8 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,812 | $2,249.6 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,918 | $2,334.4 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,812 | $2,249.6 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,677 | $2,941.6 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,300 | $2,640 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,623 | $2,898.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,733 | $2,986.4 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,733 | $2,986.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,418 | $1,934.4 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,634 | $2,107.2 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $460 | $368 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $335 | $268 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $373 | $298.4 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,786 | $3,028.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,926 | $3,140.8 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $368 | $294.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $379 | $303.2 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,786 | $3,028.8 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,521 | $2,016.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,878 | $2,302.4 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,202 | $2,561.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,975 | $3,980 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,624 | $4,499.2 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $6,111 | $4,888.8 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,725 | $2,180 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,713 | $3,770.4 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,406 | $1,124.8 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $865 | $692 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,028 | $822.4 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $765 | $612 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $928 | $742.4 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $973 | $778.4 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $984 | $787.2 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,038 | $830.4 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $337 | $269.6 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $506 | $404.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $461 | $368.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $287 | $229.6 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $54 | $43.2 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,169 | $2,535.2 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $322 | $257.6 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $416 | $332.8 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $551 | $440.8 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $226 | $180.8 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $340 | $272 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $222 | $177.6 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $151 | $120.8 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $308 | $246.4 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $249 | $199.2 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $187 | $149.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $224 | $179.2 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $35 | $35 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $61 | $48.8 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $72 | $57.6 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $162 | $129.6 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $233 | $186.4 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $153 | $122.4 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $77 | $61.6 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $140 | $112 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $86 | $68.8 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $301 | $240.8 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $198 | $190 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $255 | $255 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $457 | $368 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $103 | $82.4 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $153 | $136 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $232 | $201 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $251 | $251 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $346 | $346 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,210 | $1,768 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,965 | $2,372 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,415 | $1,932 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,832 | $2,265.6 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,127 | $2,501.6 | — | — | — |
