| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 6 | — | — | $26 | $168 | 0.95× | $210 |
| Psychiatric eval with medical services | CPT | 90792 | 6 | — | — | $26 | $208.8 | 1.2× | $261 |
| Psychotherapy 30 minutes | CPT | 90832 | 6 | — | — | $26 | $64 | 0.43× | $80 |
| Psychotherapy 45 minutes | CPT | 90834 | 6 | — | — | $26 | $88 | 0.55× | $110 |
| Psychotherapy 60 minutes | CPT | 90837 | 6 | — | — | $26 | $129.6 | 0.68× | $162 |
| emergency |
| ED visit level 1 | CPT | 99281 | 5 | — | — | $74.4 | $124.8 | 0.89× | $212 |
| ED visit level 2 | CPT | 99282 | 5 | — | — | $74.4 | $247.2 | 1.0× | $328 |
| ED visit level 3 | CPT | 99283 | 5 | — | — | $74.4 | $366.4 | 0.90× | $575 |
| ED visit level 4 | CPT | 99284 | 5 | — | — | $74.4 | $484.8 | 0.73× | $825 |
| ED visit level 5 | CPT | 99285 | 5 | — | — | $74.4 | $604.8 | 0.58× | $1,125 |
| Critical care, first hour | CPT | 99291 | 5 | — | — | $74.4 | $680 | 0.63× | $905 |
| imaging |
| CT head without contrast | CPT | 70450 | 5 | — | — | $74.4 | $1,307.3 | 6.3× | $1,700 |
| CT head with contrast | CPT | 70460 | 5 | — | — | $74.4 | $1,668.73 | 7.1× | $2,170 |
| CT head with and without contrast | CPT | 70470 | 5 | — | — | $74.4 | $1,777.93 | 6.7× | $2,312 |
| CT neck with contrast | CPT | 70491 | 5 | — | — | $74.4 | $1,668.73 | 6.1× | $2,170 |
| MRI brain without contrast | CPT | 70551 | 5 | — | — | $74.4 | $1,832.53 | 4.5× | $2,383 |
| MRI brain with contrast | CPT | 70552 | 5 | — | — | $74.4 | $2,237.03 | 4.7× | $2,909 |
| MRI brain with and without contrast | CPT | 70553 | 5 | — | — | $74.4 | $2,540.78 | 4.3× | $3,304 |
| Chest X-ray single view | CPT | 71045 | 5 | — | — | $74.4 | $152.26 | 1.6× | $198 |
| Chest X-ray 2 views | CPT | 71046 | 5 | — | — | $74.4 | $267.61 | 2.7× | $348 |
| Chest X-ray 3 views | CPT | 71047 | 5 | — | — | $74.4 | $146.88 | 1.5× | $191 |
| CT chest without contrast | CPT | 71250 | 5 | — | — | $74.4 | $1,307.3 | 6.1× | $1,700 |
| CT chest with contrast | CPT | 71260 | 5 | — | — | $74.4 | $1,831.76 | 6.5× | $2,382 |
| CT chest with and without contrast | CPT | 71270 | 5 | — | — | $74.4 | $1,936.34 | 6.6× | $2,518 |
| MRI chest without contrast | CPT | 71550 | 5 | — | — | $74.4 | $3,768.1 | 8.8× | $4,900 |
| Lumbosacral spine X-ray | CPT | 72100 | 5 | — | — | $74.4 | $220.71 | 2.1× | $287 |
| CT cervical spine without contrast | CPT | 72125 | 5 | — | — | $74.4 | $1,307.3 | 6.5× | $1,700 |
| CT thoracic spine without contrast | CPT | 72128 | 5 | — | — | $74.4 | $1,307.3 | 6.6× | $1,700 |
| CT lumbar spine without contrast | CPT | 72131 | 5 | — | — | $74.4 | $1,365.74 | 6.7× | $1,776 |
| MRI cervical spine without contrast | CPT | 72141 | 5 | — | — | $74.4 | $1,832.53 | 4.6× | $2,383 |
| MRI thoracic spine without contrast | CPT | 72146 | 5 | — | — | $74.4 | $1,832.53 | 4.9× | $2,383 |
| MRI lumbar spine without contrast | CPT | 72148 | 5 | — | — | $74.4 | $1,832.53 | 4.9× | $2,383 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 5 | — | — | $74.4 | $2,237.03 | 4.9× | $2,909 |
| MRI cervical spine with and without contrast | CPT | 72156 | 5 | — | — | $74.4 | $2,540.78 | 4.7× | $3,304 |
| MRI lumbar spine with contrast | CPT | 72158 | 5 | — | — | $74.4 | $2,540.78 | 4.6× | $3,304 |
| CT pelvis without contrast | CPT | 72192 | 5 | — | — | $74.4 | $1,260.4 | 6.3× | $1,639 |
| CT pelvis with contrast | CPT | 72193 | 5 | — | — | $74.4 | $1,831.76 | 6.5× | $2,382 |
| Shoulder X-ray | CPT | 73030 | 5 | — | — | $74.4 | $250.69 | 2.7× | $326 |
| Humerus X-ray | CPT | 73060 | 5 | — | — | $74.4 | $177.64 | 2.0× | $231 |
| Hand X-ray 3 views | CPT | 73130 | 5 | — | — | $74.4 | $197.64 | 2.1× | $257 |
| MRI upper extremity joint without contrast | CPT | 73221 | 5 | — | — | $74.4 | $1,832.53 | 4.4× | $2,383 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 5 | — | — | $74.4 | $2,540.78 | 4.2× | $3,304 |
| Knee X-ray 1-2 views | CPT | 73560 | 5 | — | — | $74.4 | $188.41 | 2.0× | $245 |
| Ankle X-ray 3 views | CPT | 73610 | 5 | — | — | $74.4 | $177.64 | 1.9× | $231 |
| MRI lower extremity joint without contrast | CPT | 73721 | 5 | — | — | $74.4 | $1,832.53 | 3.9× | $2,383 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 5 | — | — | $74.4 | $2,540.78 | 4.0× | $3,304 |
| CT abdomen without contrast | CPT | 74150 | 5 | — | — | $74.4 | $1,307.3 | 6.9× | $1,700 |
| CT abdomen with contrast | CPT | 74160 | 5 | — | — | $74.4 | $1,905.6 | 6.6× | $2,518 |
| CT abdomen with and without contrast | CPT | 74170 | 5 | — | — | $74.4 | $1,936.34 | 5.8× | $2,518 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 5 | — | — | $74.4 | $2,984.8 | 8.2× | $4,065 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 5 | — | — | $74.4 | $3,712.8 | 6.8× | $4,758 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 5 | — | — | $74.4 | $4,311.48 | 7.5× | $5,795 |
| MRI abdomen without contrast | CPT | 74181 | 5 | — | — | $74.4 | $1,832.53 | 4.7× | $2,383 |
| MRI abdomen with and without contrast | CPT | 74183 | 5 | — | — | $74.4 | $2,540.78 | 4.5× | $3,304 |
| Abdominal ultrasound complete | CPT | 76700 | 5 | — | — | $74.4 | $516.77 | 3.5× | $672 |
| Abdominal ultrasound limited | CPT | 76705 | 5 | — | — | $74.4 | $319.14 | 2.2× | $415 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 5 | — | — | $74.4 | $449.87 | 3.1× | $585 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 5 | — | — | $74.4 | $559.07 | 3.7× | $727 |
| Transvaginal ultrasound | CPT | 76830 | 5 | — | — | $74.4 | $364.51 | 2.5× | $474 |
| Pelvic ultrasound complete | CPT | 76856 | 5 | — | — | $74.4 | $461.4 | 3.2× | $600 |
| Scrotal ultrasound | CPT | 76870 | 5 | — | — | $74.4 | $393.73 | 3.0× | $512 |
| Diagnostic mammography unilateral | CPT | 77065 | 5 | — | — | $74.4 | $239.93 | 1.6× | $312 |
| Diagnostic mammography bilateral | CPT | 77066 | 5 | — | — | $74.4 | $445.26 | 2.3× | $579 |
| Screening mammography bilateral | CPT | 77067 | 5 | — | — | $74.4 | $288 | 1.8× | $384 |
| EKG complete | CPT | 93000 | 5 | — | — | $74.4 | $242.24 | 9.9× | $315 |
| EKG tracing only | CPT | 93005 | 5 | — | — | $74.4 | $197.64 | 1.7× | $257 |
| EKG interpretation only | CPT | 93010 | 5 | — | — | $50.4 | $50.4 | 2.8× | $80 |
| Transthoracic echocardiogram complete | CPT | 93306 | 5 | — | — | $74.4 | $2,443.88 | 4.1× | $3,178 |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 5 | — | — | $80 | $224 | 2.4× | $280 |
| Initial hospital care, moderate complexity | CPT | 99222 | 5 | — | — | $80 | $302.4 | 1.8× | $378 |
| Initial hospital care, high complexity | CPT | 99223 | 5 | — | — | $80 | $441.6 | 2.0× | $552 |
| Hospital discharge, <30 min | CPT | 99238 | 5 | — | — | $80 | $164.8 | 1.9× | $206 |
| Hospital discharge, >30 min | CPT | 99239 | 5 | — | — | $80 | $229.6 | 1.9× | $287 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | — | — | $74.4 | $169.18 | 5.2× | $220 |
| General health panel | CPT | 80050 | 5 | — | — | $74.4 | $336.82 | 3.1× | $438 |
| Electrolyte panel | CPT | 80051 | 5 | — | — | $74.4 | $160.73 | 6.8× | $209 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | — | — | $74.4 | $217.63 | 4.9× | $283 |
| Lipid panel | CPT | 80061 | 5 | — | — | $74.4 | $174.57 | 4.6× | $227 |
| Renal function panel | CPT | 80069 | 5 | — | — | $74.4 | $186.1 | 6.8× | $242 |
| Hepatic function panel | CPT | 80076 | 5 | — | — | $74.4 | $177.64 | 6.7× | $231 |
| Urinalysis non-automated | CPT | 81002 | 5 | — | — | $22.4 | $22.4 | 3.2× | $80 |
| Urinalysis automated | CPT | 81003 | 5 | — | — | $56.54 | $69.16 | 5.0× | $91 |
| Glucose quantitative | CPT | 82947 | 5 | — | — | $67.7 | $78.38 | 4.5× | $91 |
| Hemoglobin A1c | CPT | 83036 | 5 | — | — | $74.4 | $94.59 | 3.5× | $123 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | — | — | $74.4 | $182.26 | 3.9× | $237 |
| Complete blood count with automated differential | CPT | 85025 | 5 | — | — | $74.4 | $117.66 | 4.4× | $153 |
| Urine culture bacterial | CPT | 87086 | 5 | — | — | $74.4 | $89.5 | 3.8× | $150 |
| Tissue exam by pathologist level IV | CPT | 88305 | 5 | — | — | $74.4 | $201.48 | 2.0× | $262 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 6 | — | — | $26 | $162 | 1.9× | $250 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 6 | — | — | $26 | $209.7 | 1.7× | $308 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 6 | — | — | $26 | $291.2 | 1.7× | $395 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 6 | — | — | $26 | $334 | 1.5× | $444 |
| Office visit, established patient, 5 min | CPT | 99211 | 6 | — | — | $26 | $76 | 1.2× | $116 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 6 | — | — | $26 | $80.8 | 1.0× | $101 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 6 | — | — | $26 | $104 | 0.91× | $130 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 6 | — | — | $26 | $150.4 | 0.99× | $188 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 6 | — | — | $26 | $270 | 1.4× | $404 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 5 | — | — | $80 | $1,153.6 | 1.3× | $1,442 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 5 | — | — | $80 | $1,432.8 | 1.5× | $1,791 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 5 | — | — | $80 | $514.4 | 0.61× | $643 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 5 | — | — | $80 | $581.6 | 0.65× | $727 |
| Colonoscopy diagnostic | CPT | 45378 | 5 | — | — | $80 | $1,612 | 1.8× | $2,015 |
| Colonoscopy with biopsy | CPT | 45380 | 5 | — | — | $80 | $1,942.4 | 1.6× | $2,428 |
| Colonoscopy with polyp removal | CPT | 45385 | 5 | — | — | $80 | $2,016 | 1.7× | $2,520 |
| surgery |
| Laparoscopic appendectomy | CPT | 44970 | 5 | — | — | $80 | $3,130.4 | 2.0× | $3,913 |
| Laparoscopic cholecystectomy | CPT | 47562 | 5 | — | — | $80 | $3,920 | 2.2× | $4,900 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 5 | — | — | $80 | $4,182.4 | 2.2× | $5,228 |
| Open umbilical hernia repair | CPT | 49560 | 5 | — | — | $80 | $2,878.4 | 1.5× | $3,598 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 5 | — | — | $80 | $2,259.2 | 1.7× | $2,824 |
| Lap inguinal hernia repair | CPT | 49650 | 5 | — | — | $80 | $1,844 | 1.6× | $2,305 |
| Lap incisional hernia repair | CPT | 49652 | 5 | — | — | $80 | $3,364 | 1.2× | $4,205 |