| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $496 | $277.76 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $473 | $264.88 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $209 | $117.04 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $278 | $155.68 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $417 | $233.52 | — | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $410 | $229.6 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $190 | $106.4 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $285 | $159.6 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $460 | $257.6 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $749 | $419.44 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,725 | $966 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,266 | $1,268.96 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,209 | $1,237.04 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,286 | $1,280.16 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,209 | $1,237.04 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,561 | $1,434.16 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $324 | $181.44 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $390 | $218.4 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $380 | $212.8 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,209 | $1,237.04 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,286 | $1,280.16 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,561 | $1,434.16 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $422 | $236.32 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,602 | $897.12 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,561 | $1,434.16 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,209 | $1,237.04 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $245 | $137.2 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $237 | $132.72 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $277 | $155.12 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $324 | $181.44 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $287 | $160.72 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,602 | $897.12 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,209 | $1,237.04 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,286 | $1,280.16 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,205 | $1,794.8 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,416 | $2,472.96 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,570 | $2,559.2 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,308 | $1,292.48 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,629 | $1,472.24 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $907 | $507.92 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $827 | $463.12 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $906 | $507.36 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $772 | $432.32 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $907 | $507.92 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,015 | $568.4 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $907 | $507.92 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $832 | $465.92 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $533 | $298.48 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $675 | $378 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $559 | $313.04 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $247 | $138.32 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $30 | $16.8 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,333 | $1,306.48 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,742 | $975.52 | — | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $410 | $229.6 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $558 | $312.48 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $820 | $459.2 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $292 | $163.52 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $410 | $229.6 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $109 | $61.04 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $96 | $53.76 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $137 | $76.72 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $149 | $83.44 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $125 | $70 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $105 | $58.8 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $23 | $12.88 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $69 | $38.64 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $60 | $33.6 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $89 | $49.84 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $149 | $83.44 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $111 | $62.16 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $109 | $61.04 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $59 | $33.04 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $457 | $255.92 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $507 | $283.92 | — | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $8,304 | $4,650.24 | — | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $2,959 | $1,657.04 | — | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $4,150 | $2,324 | — | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $9,192 | $5,147.52 | — | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $3,332 | $1,865.92 | — | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $5,018 | $2,810.08 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $204 | $114.24 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $309 | $173.04 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $528 | $295.68 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $677 | $379.12 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $282 | $157.92 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $106 | $59.36 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $207 | $115.92 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $321 | $179.76 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $455 | $254.8 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,100 | $616 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,170 | $655.2 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $588 | $329.28 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $750 | $420 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,121 | $627.76 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,384 | $775.04 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,455 | $814.8 | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $6,889 | $3,857.84 | — | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $7,515 | $4,208.4 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $10,578 | $5,923.68 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $6,439 | $3,605.84 | — | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $5,874 | $3,289.44 | — | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $7,716 | $4,320.96 | — | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $3,830 | $2,144.8 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $4,570 | $2,559.2 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $3,204 | $1,794.24 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $5,875 | $3,290 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,860 | $1,041.6 | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $1,952 | $1,093.12 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $2,213 | $1,239.28 | — | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $2,283 | $1,278.48 | — | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $1,624 | $909.44 | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,326 | $742.56 | — | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $2,101 | $1,176.56 | — | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $4,081 | $2,285.36 | — | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,423 | $1,916.88 | — | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $3,652 | $2,045.12 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $4,051 | $2,268.56 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $2,715 | $1,520.4 | — | — | — | — |