| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $401.8 | $337.51 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $457.9 | $384.64 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $197 | $165.48 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $267.7 | $224.87 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $526.4 | $442.18 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $393.3 | $330.37 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $210.1 | $176.48 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $304.5 | $255.78 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $635.5 | $533.82 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $968.7 | $813.71 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,369.8 | $1,150.63 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,626.9 | $1,366.6 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,839.6 | $1,545.26 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,922.6 | $1,614.98 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,150.5 | $1,806.42 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,318.5 | $1,947.54 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,278.1 | $2,753.6 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,771.6 | $4,008.14 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,935.8 | $4,146.07 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $352.4 | $296.02 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $266.9 | $224.2 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,997 | $1,677.48 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,997 | $1,677.48 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,417.2 | $2,030.45 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,982.4 | $2,505.22 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,459.4 | $3,745.9 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $219.4 | $184.3 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,127.9 | $1,787.44 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,949.4 | $1,637.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,359.8 | $1,982.23 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,764.8 | $3,162.43 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,764.8 | $3,162.43 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,949.4 | $1,637.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,949.4 | $1,637.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $455.8 | $382.87 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $418.7 | $351.71 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $408.3 | $342.97 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $7,160.3 | $6,014.65 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,485.5 | $3,767.82 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $425.2 | $357.17 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $504.3 | $423.61 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $7,212.9 | $6,058.84 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $7,713 | $6,478.92 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,080.7 | $1,747.79 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,080.7 | $1,747.79 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,414.2 | $2,027.93 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,288 | $1,921.92 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,269.9 | $2,746.72 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,269.9 | $2,746.72 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,136.5 | $2,634.66 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,687.9 | $3,937.84 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,228.9 | $1,032.28 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $631.7 | $530.63 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,473.7 | $1,237.91 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $702 | $589.68 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $737.2 | $619.25 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $737.2 | $619.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $737.2 | $619.25 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $608.3 | $510.97 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $571.6 | $480.14 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $714.7 | $600.35 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $410 | $344.4 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $357.5 | $300.3 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $207.8 | $174.55 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $157 | $131.88 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,040.4 | $1,713.94 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,704 | $1,431.36 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $220 | $184.8 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $293.4 | $246.46 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $372.7 | $313.07 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $146.6 | $123.14 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $220 | $184.8 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $183.7 | $154.31 | — | — | — |
| General health panel | CPT | 80050 | 0 | $508.2 | $426.89 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $179.1 | $150.44 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $204.2 | $171.53 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $211.9 | $178 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $197.7 | $166.07 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $186.7 | $156.83 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $63.5 | $53.34 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $77.7 | $65.27 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $90.6 | $76.1 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $153.5 | $128.94 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $303.4 | $254.86 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $101.6 | $85.34 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $126.8 | $106.51 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $127.6 | $107.18 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $128.2 | $107.69 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $366 | $307.44 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $545.2 | $457.97 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $3,010.5 | $2,528.82 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,054.7 | $1,725.95 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $3,512.4 | $2,950.42 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,348.2 | $1,972.49 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,939.7 | $3,309.35 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $214.2 | $179.93 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $312.4 | $262.42 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $362.3 | $304.33 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $595.4 | $500.14 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $82 | $68.88 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $138.6 | $116.42 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $205.2 | $172.37 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $313.4 | $263.26 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $425.9 | $357.76 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $910.1 | $764.48 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,081.8 | $908.71 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $437.8 | $367.75 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $669.48 | $562.36 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,356 | $1,139.04 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,491.7 | $1,253.03 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,856.3 | $1,559.29 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $3,316.65 | $2,785.99 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,016.7 | $3,374.03 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $4,804.5 | $4,035.78 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $4,802.1 | $4,033.76 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $4,985.3 | $4,187.65 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $6,234.1 | $5,236.64 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $622.4 | $522.82 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $3,769.9 | $3,166.72 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,918.2 | $1,611.29 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $3,487.1 | $2,929.16 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $1,880 | $1,579.2 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,765.1 | $1,482.68 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $1,929.5 | $1,620.78 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,093.9 | $1,758.88 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $3,261.4 | $2,739.58 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,010.5 | $2,528.82 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,010.5 | $2,528.82 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $3,261.4 | $2,739.58 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $2,069.7 | $1,738.55 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $7,721.3 | $6,485.89 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $7,650.4 | $6,426.34 | — | — | — |
