| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 20 | $350 | $122.5 | $122.11 | $140.76 | $262.5 |
| Psychiatric eval with medical services | CPT | 90792 | 20 | $380 | $133 | $124.44 | $161.37 | $285 |
| Psychotherapy 30 minutes | CPT | 90832 | 23 | $350.2 | $129.58 | $46.98 | $102.57 | $297.67 |
| Psychotherapy 45 minutes | CPT | 90834 | 23 | $589.62 | $218.16 | $62.03 | $170.99 | $501.18 |
| Psychotherapy 60 minutes | CPT | 90837 | 23 | $403.76 | $149.4 | $80.75 | $161.84 | $343.2 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 20 | $295 | $103.25 | $88.59 | $128.33 | $221.25 |
| emergency |
| ED visit level 1 | CPT | 99281 | 23 | $502.8 | $186.04 | $10.42 | $145.81 | $427.38 |
| ED visit level 2 | CPT | 99282 | 23 | $685.24 | $253.54 | $28.88 | $198.72 | $582.45 |
| ED visit level 3 | CPT | 99283 | 23 | $815.39 | $301.7 | $49.16 | $236.46 | $693.08 |
| ED visit level 4 | CPT | 99284 | 23 | $1,168.02 | $432.17 | $83.69 | $338.73 | $992.82 |
| ED visit level 5 | CPT | 99285 | 23 | $1,561.81 | $577.87 | $121.28 | $452.92 | $1,327.54 |
| Critical care, first hour | CPT | 99291 | 23 | $3,247.1 | $1,201.43 | $145.5 | $941.66 | $2,760.04 |
| imaging |
| CT head without contrast | CPT | 70450 | 23 | $3,878.26 | $1,434.96 | $35.78 | $154.35 | $3,296.52 |
| CT head with contrast | CPT | 70460 | 23 | $3,878.26 | $1,434.96 | $82.4 | $853.22 | $3,296.52 |
| CT head with and without contrast | CPT | 70470 | 23 | $6,149.41 | $2,275.29 | $82.25 | $1,352.87 | $5,227 |
| CT neck with contrast | CPT | 70491 | 23 | $5,777.91 | $2,137.83 | $61.14 | $602 | $4,911.22 |
| MRI brain without contrast | CPT | 70551 | 23 | $7,326.62 | $2,710.85 | $109.58 | $1,093 | $6,227.63 |
| MRI brain with contrast | CPT | 70552 | 23 | $7,406.11 | $2,740.27 | $136.14 | $1,629.35 | $6,295.19 |
| MRI brain with and without contrast | CPT | 70553 | 23 | $9,695.65 | $3,587.4 | $151.2 | $1,476.75 | $8,241.3 |
| Chest X-ray single view | CPT | 71045 | 23 | $498.52 | $184.46 | $5.7 | $33.81 | $423.74 |
| Chest X-ray 2 views | CPT | 71046 | 23 | $649.78 | $240.42 | $7.03 | $39.72 | $552.31 |
| Chest X-ray 3 views | CPT | 71047 | 23 | $723.06 | $267.54 | $18.5 | $209.69 | $614.6 |
| CT chest without contrast | CPT | 71250 | 23 | $5,788.19 | $2,141.64 | $45.31 | $219.7 | $4,919.96 |
| CT chest with contrast | CPT | 71260 | 23 | $6,149.41 | $2,275.29 | $48.82 | $273.1 | $5,227 |
| CT chest with and without contrast | CPT | 71270 | 23 | $8,453 | $3,127.61 | $66.23 | $743.25 | $7,185.05 |
| MRI chest without contrast | CPT | 71550 | 23 | $7,406.11 | $2,740.27 | $111.8 | $1,629.35 | $6,295.19 |
| MRI chest with contrast | CPT | 71551 | 23 | $7,406.11 | $2,740.27 | $132.4 | $1,629.35 | $6,295.19 |
| MRI chest with and without contrast | CPT | 71552 | 23 | $9,695.65 | $3,587.4 | $172.8 | $2,133.05 | $8,241.3 |
| Lumbosacral spine X-ray | CPT | 72100 | 23 | $959.08 | $354.86 | $14.35 | $57.96 | $815.22 |
| CT cervical spine without contrast | CPT | 72125 | 23 | $5,897.96 | $2,182.25 | $44.53 | $602 | $5,013.27 |
| CT thoracic spine without contrast | CPT | 72128 | 23 | $5,857.4 | $2,167.24 | $44.53 | $602 | $4,978.79 |
| CT lumbar spine without contrast | CPT | 72131 | 23 | $6,420.32 | $2,375.52 | $41.66 | $225.05 | $5,457.27 |
| MRI cervical spine without contrast | CPT | 72141 | 23 | $7,406.11 | $2,740.27 | $62.31 | $304.26 | $6,295.19 |
| MRI thoracic spine without contrast | CPT | 72146 | 23 | $7,406.11 | $2,740.27 | $62.31 | $303.76 | $6,295.19 |
| MRI lumbar spine without contrast | CPT | 72148 | 23 | $7,406.11 | $2,740.27 | $62.31 | $369.33 | $6,295.19 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 23 | $7,406.11 | $2,740.27 | $75.63 | $378.89 | $6,295.19 |
| MRI cervical spine with and without contrast | CPT | 72156 | 23 | $9,695.65 | $3,587.4 | $175 | $2,326.96 | $8,241.3 |
| MRI lumbar spine with contrast | CPT | 72158 | 23 | $9,695.65 | $3,587.4 | $91.95 | $520.14 | $8,241.3 |
| CT pelvis without contrast | CPT | 72192 | 23 | $5,104.68 | $1,888.74 | $44.22 | $167.4 | $4,338.98 |
| CT pelvis with contrast | CPT | 72193 | 23 | $5,795.76 | $2,144.44 | $49.54 | $353.68 | $4,926.4 |
| Shoulder X-ray | CPT | 73030 | 23 | $674.7 | $249.64 | $11.26 | $52.69 | $573.5 |
| Humerus X-ray | CPT | 73060 | 23 | $631.65 | $233.72 | $10.3 | $48.74 | $536.9 |
| Hand X-ray 3 views | CPT | 73130 | 23 | $622.02 | $230.15 | $11.98 | $57.44 | $528.72 |
| MRI upper extremity joint without contrast | CPT | 73221 | 23 | $7,326.62 | $2,710.85 | $96.1 | $1,155.6 | $6,227.63 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 23 | $9,695.65 | $3,587.4 | $165 | $2,133.05 | $8,241.3 |
| Hip X-ray 2 views | CPT | 73510 | 5 | $118 | $41.3 | $25.9 | $54.39 | $88.5 |
| Knee X-ray 1-2 views | CPT | 73560 | 23 | $587.46 | $217.37 | $11.03 | $52.88 | $499.34 |
| Ankle X-ray 3 views | CPT | 73610 | 23 | $584.06 | $216.11 | $13.6 | $56.43 | $496.45 |
| MRI lower extremity joint without contrast | CPT | 73721 | 23 | $7,406.11 | $2,740.27 | $96.25 | $1,093 | $6,295.19 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 23 | $9,695.65 | $3,587.4 | $164.5 | $2,133.05 | $8,241.3 |
| CT abdomen without contrast | CPT | 74150 | 23 | $3,882.59 | $1,436.56 | $45.47 | $221.67 | $3,300.2 |
| CT abdomen with contrast | CPT | 74160 | 23 | $3,882.59 | $1,436.56 | $53.37 | $372.33 | $3,300.2 |
| CT abdomen with and without contrast | CPT | 74170 | 23 | $6,149.41 | $2,275.29 | $58.38 | $353.7 | $5,227 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 23 | $8,477.33 | $3,136.62 | $55.48 | $1,148.74 | $7,205.73 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 23 | $9,130.02 | $3,378.11 | $57.95 | $1,220.5 | $7,760.52 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 23 | $11,602 | $4,292.87 | $63.87 | $2,990.5 | $9,861.98 |
| MRI abdomen without contrast | CPT | 74181 | 23 | $7,406.11 | $2,740.27 | $93.05 | $1,101.6 | $6,295.19 |
| MRI abdomen with and without contrast | CPT | 74183 | 23 | $9,695.65 | $3,587.4 | $159.98 | $1,800 | $8,241.3 |
| Abdominal ultrasound complete | CPT | 76700 | 23 | $2,140.34 | $791.93 | $26.56 | $121.14 | $1,819.29 |
| Abdominal ultrasound limited | CPT | 76705 | 23 | $1,869.97 | $691.89 | $21.32 | $80.41 | $1,589.47 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 23 | $2,140.34 | $791.93 | $37.95 | $158.95 | $1,819.29 |
| Obstetric ultrasound first trimester | CPT | 76801 | 23 | $1,865.85 | $690.37 | $31.49 | $107.35 | $1,585.97 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 23 | $2,134.68 | $789.84 | $31.69 | $123.77 | $1,814.48 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 19 | $599 | $209.65 | $60.07 | $133.52 | $449.25 |
| Transvaginal ultrasound | CPT | 76830 | 23 | $1,176.78 | $435.41 | $29.17 | $108.35 | $1,000.26 |
| Pelvic ultrasound complete | CPT | 76856 | 23 | $2,140.34 | $791.93 | $28.89 | $102.91 | $1,819.29 |
| Scrotal ultrasound | CPT | 76870 | 23 | $2,050.73 | $758.78 | $26.84 | $108.1 | $1,743.12 |
| Diagnostic mammography unilateral | CPT | 77065 | 23 | $450.11 | $166.55 | $57.75 | $193.54 | $382.59 |
| Diagnostic mammography bilateral | CPT | 77066 | 23 | $757.05 | $280.11 | $70 | $309.63 | $643.49 |
| Screening mammography bilateral | CPT | 77067 | 23 | $357.93 | $132.44 | $50.4 | $154.63 | $304.24 |
| EKG complete | CPT | 93000 | 19 | $82 | $28.7 | $12.65 | $13.64 | $61.5 |
| EKG tracing only | CPT | 93005 | 23 | $531 | $196.47 | $5.47 | $153.99 | $451.35 |
| EKG interpretation only | CPT | 93010 | 19 | $49 | $17.15 | $7.18 | $7.81 | $36.75 |
| Transthoracic echocardiogram complete | CPT | 93306 | 23 | $3,901.5 | $1,443.56 | $45.71 | $271.43 | $3,316.28 |
| Transthoracic echocardiogram | CPT | 93307 | 23 | $4,135.45 | $1,530.12 | $32.76 | $125.07 | $3,515.13 |
| Stress echocardiogram | CPT | 93350 | 19 | $591 | $206.85 | $59.88 | $141.48 | $443.25 |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 19 | $218 | $76.3 | $61.76 | $78.31 | $163.5 |
| Initial hospital care, moderate complexity | CPT | 99222 | 19 | $322 | $112.7 | $88.82 | $122.84 | $241.5 |
| Initial hospital care, high complexity | CPT | 99223 | 19 | $468 | $163.8 | $121.97 | $163.68 | $351 |
| Hospital discharge, <30 min | CPT | 99238 | 19 | $191 | $66.85 | $54.59 | $76.12 | $143.25 |
| Hospital discharge, >30 min | CPT | 99239 | 19 | $263 | $92.05 | $77.02 | $107.49 | $197.25 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 23 | $297.67 | $110.14 | $3.5 | $86.32 | $253.02 |
| General health panel | CPT | 80050 | 6 | $145 | $50.75 | $3.5 | $50.75 | $108.75 |
| Electrolyte panel | CPT | 80051 | 23 | $263.68 | $97.57 | $3.5 | $76.47 | $224.13 |
| Comprehensive metabolic panel | CPT | 80053 | 23 | $314.15 | $116.24 | $3.5 | $91.1 | $267.03 |
| Lipid panel | CPT | 80061 | 23 | $299.73 | $110.91 | $3.5 | $86.92 | $254.77 |
| Renal function panel | CPT | 80069 | 23 | $299.73 | $110.91 | $3.5 | $86.92 | $254.77 |
| Hepatic function panel | CPT | 80076 | 23 | $297.67 | $110.14 | $3.5 | $86.32 | $253.02 |
| Urinalysis non-automated | CPT | 81002 | 21 | $18 | $6.3 | $3.31 | $3.55 | $13.5 |
| Urinalysis automated | CPT | 81003 | 23 | $79.31 | $29.35 | $2.14 | $23 | $67.41 |
| Glucose quantitative | CPT | 82947 | 23 | $145.23 | $53.74 | $3.5 | $42.12 | $123.45 |
| Hemoglobin A1c | CPT | 83036 | 23 | $263.68 | $97.57 | $3.5 | $76.47 | $224.13 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 23 | $338.87 | $125.39 | $3.5 | $98.27 | $288.04 |
| Complete blood count with automated differential | CPT | 85025 | 23 | $231.75 | $85.75 | $3.5 | $67.21 | $196.99 |
| Complete blood count without differential | CPT | 85027 | 23 | $265.74 | $98.33 | $2.11 | $77.06 | $225.88 |
| Urine culture bacterial | CPT | 87086 | 23 | $185.4 | $68.6 | $3.5 | $53.77 | $157.59 |
| Urine culture identification | CPT | 87088 | 21 | $59 | $20.65 | $3.5 | $8.09 | $44.25 |
| Tissue exam by pathologist level IV | CPT | 88305 | 23 | $375 | $131.25 | $22.47 | $65.18 | $281.25 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 19 | $214 | $74.9 | $7.9 | $46.34 | $160.5 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 19 | $6,700 | $2,345 | $1,840.25 | $2,372.62 | $6,581.99 |
| Vaginal delivery only | CPT | 59409 | 19 | $3,200 | $1,120 | $754.44 | $924.45 | $2,400 |
| Vaginal delivery with postpartum | CPT | 59410 | 19 | $3,663 | $1,282.05 | $924.45 | $1,083.27 | $2,974.1 |
| Routine obstetric care with C-section | CPT | 59510 | 19 | $7,200 | $2,520 | $2,046.31 | $2,652.52 | $7,365.44 |
| C-section delivery only | CPT | 59514 | 19 | $3,268 | $1,143.8 | $860.76 | $933.05 | $2,513.6 |
| C-section with postpartum | CPT | 59515 | 19 | $3,524 | $1,233.4 | $1,070.45 | $1,336.85 | $3,709.68 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 20 | $172 | $60.2 | $32.21 | $45.05 | $129 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 20 | $249 | $87.15 | $55.95 | $78.59 | $186.75 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 20 | $369 | $129.15 | $90.81 | $128.08 | $276.75 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 20 | $451 | $157.85 | $123.49 | $172.14 | $338.25 |
| Office visit, established patient, 5 min | CPT | 99211 | 20 | $55 | $19.25 | $7.76 | $8.44 | $41.25 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 20 | $105 | $36.75 | $24.25 | $33.09 | $78.75 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 20 | $170 | $59.5 | $44.67 | $63.33 | $127.5 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 20 | $248 | $86.8 | $65.79 | $91.55 | $186 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 20 | $327 | $114.45 | $97.69 | $135.18 | $245.25 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 20 | $905 | $316.75 | $110.04 | $118.42 | $678.75 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 20 | $1,075 | $376.25 | $123.49 | $133.93 | $806.25 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 20 | $389 | $136.15 | $54.73 | $102.36 | $291.75 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 20 | $525 | $183.75 | $65.22 | $70.02 | $393.75 |
| Colonoscopy diagnostic | CPT | 45378 | 22 | $1,269 | $444.15 | $165.78 | $187.53 | $2,186 |
| Colonoscopy with biopsy | CPT | 45380 | 20 | $1,517 | $530.95 | $180.37 | $193.8 | $1,137.75 |
| Colonoscopy with polyp removal | CPT | 45385 | 20 | $1,698 | $594.3 | $226.96 | $245.44 | $1,273.5 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 19 | $5,450 | $1,907.5 | $1,329.16 | $1,427.97 | $4,087.5 |
| Hip hemiarthroplasty | CPT | 27125 | 19 | $5,080 | $1,778 | $1,026.65 | $1,109.66 | $3,810 |
| Total hip replacement | CPT | 27130 | 19 | $6,157 | $2,154.95 | $1,184.66 | $1,271.96 | $4,617.75 |
| Total knee replacement | CPT | 27447 | 19 | $6,094 | $2,132.9 | $1,183.11 | $1,270.29 | $4,570.5 |
| Knee revision arthroplasty single component | CPT | 27486 | 19 | $4,453 | $1,558.55 | $972.13 | $1,376.55 | $3,741.27 |
| Knee revision arthroplasty all components | CPT | 27487 | 19 | $6,529 | $2,285.15 | $1,473.3 | $1,716.86 | $4,896.75 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 19 | $3,876 | $1,356.6 | $158.37 | $170.03 | $2,907 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 19 | $4,850 | $1,697.5 | $738.81 | $1,044.43 | $3,637.5 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 19 | $3,400 | $1,190 | $186.55 | $534.49 | $2,550 |
| ACL reconstruction | CPT | 29888 | 19 | $6,870 | $2,404.5 | $673.62 | $951.8 | $5,152.5 |
| CABG single arterial graft | CPT | 33533 | 19 | $8,296 | $2,903.6 | $1,727.87 | $1,866.78 | $6,222 |
| CABG 2 arterial grafts | CPT | 33534 | 19 | $9,863 | $3,452.05 | $2,030.8 | $2,193.7 | $7,397.25 |
| CABG 3 arterial grafts | CPT | 33535 | 19 | $10,505 | $3,676.75 | $2,256.69 | $2,422.97 | $7,878.75 |
| CABG 4+ arterial grafts | CPT | 33536 | 7 | $5,992 | $2,097.2 | $2,097.2 | $4,314.24 | $7,081.3 |
| Open appendectomy | CPT | 44950 | 19 | $2,310 | $808.5 | $453.3 | $638.78 | $1,744.55 |
| Laparoscopic appendectomy | CPT | 44970 | 19 | $1,950 | $682.5 | $424.25 | $598.87 | $1,632.74 |
| Laparoscopic cholecystectomy | CPT | 47562 | 20 | $2,906 | $1,017.1 | $619.25 | $664.88 | $7,500 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 20 | $3,421 | $1,197.35 | $506.77 | $723.69 | $7,500 |
| Open umbilical hernia repair | CPT | 49560 | 5 | $2,558 | $895.3 | $895.3 | $1,788.04 | $1,918.5 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 5 | $1,828 | $639.8 | $639.8 | $1,277.77 | $1,371 |
| Lap inguinal hernia repair | CPT | 49650 | 19 | $1,889 | $661.15 | $387.05 | $430.72 | $1,416.75 |
| Lap incisional hernia repair | CPT | 49652 | 5 | $2,800 | $980 | $980 | $1,957.2 | $2,100 |
| Total abdominal hysterectomy | CPT | 58150 | 19 | $4,520 | $1,582 | $772.7 | $993.07 | $3,390 |
| Vaginal hysterectomy | CPT | 58260 | 19 | $4,413 | $1,544.55 | $725.6 | $816.21 | $3,309.75 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 19 | $4,250 | $1,487.5 | $725.6 | $860.45 | $3,187.5 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 19 | $4,381 | $1,533.35 | $725 | $957.09 | $3,285.75 |
| Lap salpingo-oophorectomy | CPT | 58661 | 19 | $4,000 | $1,400 | $480 | $636.99 | $3,000 |
| Complex cataract surgery | CPT | 66982 | 19 | $3,938 | $1,378.3 | $587.6 | $690.37 | $2,953.5 |
| Cataract surgery with lens implant | CPT | 66984 | 19 | $3,841 | $1,344.35 | $473.52 | $511.61 | $2,880.75 |
| Intravitreal injection | CPT | 67028 | 20 | $790 | $276.5 | $81.18 | $87.16 | $592.5 |
| Vitrectomy mechanical | CPT | 67042 | 19 | $4,421 | $1,547.35 | $753.46 | $1,057.95 | $3,315.75 |
| PCI single major coronary artery | CPT | 92920 | 19 | $1,446 | $506.1 | $366.81 | $509.75 | $1,084.5 |
| PCI with drug-eluting stent | CPT | 92928 | 19 | $1,650 | $577.5 | $408.11 | $571.79 | $1,237.5 |
| PCI bypass graft | CPT | 92937 | 19 | $1,650 | $577.5 | $408.19 | $571.48 | $1,237.5 |
| Left heart catheterization | CPT | 93452 | 19 | $2,215 | $775.25 | $162.24 | $283.94 | $1,661.25 |
| Coronary angiography with cath | CPT | 93455 | 19 | $2,627 | $919.45 | $191.06 | $355.76 | $1,970.25 |
| Coronary angiography with bypass cath | CPT | 93458 | 19 | $2,708 | $947.8 | $202.36 | $375.04 | $2,031 |