| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $229 | $183.2 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $658 | $526.4 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $691 | $552.8 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $891 | $712.8 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,150 | $920 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,039 | $831.2 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,893 | $1,514.4 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,598 | $1,278.4 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,115 | $1,692 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,908 | $1,526.4 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,666 | $1,332.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,889 | $1,511.2 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,541 | $2,832.8 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $164 | $131.2 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $246 | $196.8 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $175 | $140 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,041 | $1,632.8 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,172 | $1,737.6 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,713 | $1,370.4 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,558 | $1,246.4 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,868 | $1,494.4 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,271 | $2,616.8 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $254 | $203.2 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,775 | $1,420 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,763 | $1,410.4 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,763 | $1,410.4 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,770 | $1,416 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,741 | $1,392.8 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,367 | $1,893.6 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,892 | $1,513.6 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,371 | $2,696.8 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,337 | $2,669.6 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,698 | $1,358.4 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,947 | $1,557.6 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $168 | $134.4 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $162 | $129.6 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $168 | $134.4 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,614 | $1,291.2 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,265 | $2,612 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $162 | $129.6 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $168 | $134.4 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,666 | $1,332.8 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,265 | $2,612 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,698 | $1,358.4 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,824 | $1,459.2 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,713 | $1,370.4 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,398 | $2,718.4 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,921 | $3,136.8 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,429 | $2,743.2 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,558 | $1,246.4 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,289 | $2,631.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $444 | $355.2 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $375 | $300 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $444 | $355.2 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $421 | $336.8 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $421 | $336.8 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $770 | $616 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $466 | $372.8 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $378 | $302.4 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $476 | $380.8 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $294 | $235.2 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $353 | $282.4 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $396 | $316.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $194 | $155.2 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,706 | $1,364.8 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $603 | $482.4 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $197 | $157.6 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $305 | $244 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $356 | $284.8 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $136 | $108.8 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $190 | $152 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $91 | $72.8 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $75 | $60 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $113 | $90.4 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $90 | $72 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $92 | $73.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $85 | $68 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $21 | $16.8 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $54.24 | $43.39 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $93.88 | $75.1 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $44 | $35.2 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $44 | $35.2 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $16.25 | $13 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $26.7 | $21.36 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $257 | $205.6 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $202 | $161.6 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $215 | $172 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $246 | $196.8 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $397 | $317.6 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $631 | $504.8 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $246 | $196.8 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $178 | $142.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $200 | $160 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $319 | $255.2 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $427 | $341.6 | — | — | — |
