| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 26 | $516 | $154.8 | $211.56 | $298.25 | $423.12 |
| Psychotherapy 30 minutes | CPT | 90832 | 22 | $516 | $154.8 | $211.56 | $258 | $516 |
| Psychotherapy 45 minutes | CPT | 90834 | 22 | $361 | $108.3 | $148.01 | $180.5 | $361 |
| Psychotherapy 60 minutes | CPT | 90837 | 22 | $516 | $154.8 | $211.56 | $258 | $516 |
| emergency |
| ED visit level 1 | CPT | 99281 | 12 | $464 | $139.2 | $162.4 | $162.4 | $464 |
| ED visit level 2 | CPT | 99282 | 12 | $1,041 | $312.3 | $364.35 | $364.35 | $1,041 |
| ED visit level 3 | CPT | 99283 | 12 | $1,956 | $586.8 | $684.6 | $684.6 | $1,956 |
| ED visit level 4 | CPT | 99284 | 12 | $2,077 | $623.1 | $726.95 | $726.95 | $2,077 |
| ED visit level 5 | CPT | 99285 | 12 | $2,811 | $843.3 | $983.85 | $983.85 | $2,811 |
| Critical care, first hour | CPT | 99291 | 12 | $4,787 | $1,436.1 | $1,675.45 | $1,675.45 | $4,787 |
| imaging |
| CT head without contrast | CPT | 70450 | 19 | $1,865.85 | $559.75 | $765 | $765 | $1,865.85 |
| CT head with contrast | CPT | 70460 | 19 | $2,100.53 | $630.16 | $861.22 | $861.22 | $2,100.53 |
| CT head with and without contrast | CPT | 70470 | 19 | $2,292.41 | $687.72 | $939.89 | $939.89 | $2,292.41 |
| CT neck with contrast | CPT | 70491 | 19 | $1,866.38 | $559.91 | $765.22 | $765.22 | $1,866.38 |
| MRI brain without contrast | CPT | 70551 | 19 | $2,434.69 | $730.41 | $998.22 | $998.22 | $2,434.69 |
| MRI brain with contrast | CPT | 70552 | 19 | $2,755.46 | $826.64 | $1,129.74 | $1,129.74 | $2,755.46 |
| MRI brain with and without contrast | CPT | 70553 | 19 | $3,075.45 | $922.63 | $1,260.93 | $1,260.93 | $3,075.45 |
| Chest X-ray single view | CPT | 71045 | 24 | $647 | $194.1 | $265.27 | $373.97 | $647 |
| Chest X-ray 2 views | CPT | 71046 | 23 | $731 | $219.3 | $299.71 | $422.52 | $599.42 |
| Chest X-ray 3 views | CPT | 71047 | 9 | $836 | $250.8 | $342.76 | $342.76 | $836 |
| CT chest without contrast | CPT | 71250 | 19 | $1,718.33 | $515.5 | $704.52 | $704.52 | $1,718.33 |
| CT chest with contrast | CPT | 71260 | 19 | $1,969.8 | $590.94 | $807.62 | $807.62 | $1,969.8 |
| CT chest with and without contrast | CPT | 71270 | 19 | $2,221.54 | $666.46 | $910.83 | $910.83 | $2,221.54 |
| MRI chest without contrast | CPT | 71550 | 19 | $3,347.14 | $1,004.14 | $1,372.33 | $1,372.33 | $3,347.14 |
| MRI chest with contrast | CPT | 71551 | 9 | $3,532.99 | $1,059.9 | $1,448.53 | $1,448.53 | $3,532.99 |
| MRI chest with and without contrast | CPT | 71552 | 19 | $5,372.06 | $1,611.62 | $2,202.54 | $2,202.54 | $5,372.06 |
| Lumbosacral spine X-ray | CPT | 72100 | 23 | $1,514 | $454.2 | $620.74 | $875.09 | $1,241.48 |
| CT cervical spine without contrast | CPT | 72125 | 19 | $2,282.44 | $684.73 | $935.8 | $935.8 | $2,282.44 |
| CT thoracic spine without contrast | CPT | 72128 | 19 | $2,097.9 | $629.37 | $860.14 | $860.14 | $2,097.9 |
| CT lumbar spine without contrast | CPT | 72131 | 19 | $2,226 | $667.8 | $912.66 | $912.66 | $2,226 |
| MRI cervical spine without contrast | CPT | 72141 | 19 | $2,428.39 | $728.52 | $995.64 | $995.64 | $2,428.39 |
| MRI thoracic spine without contrast | CPT | 72146 | 19 | $2,789.85 | $836.95 | $1,143.84 | $1,143.84 | $2,789.85 |
| MRI lumbar spine without contrast | CPT | 72148 | 19 | $2,789.85 | $836.95 | $1,143.84 | $1,143.84 | $2,789.85 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 9 | $3,071.25 | $921.37 | $1,259.21 | $1,259.21 | $3,071.25 |
| MRI cervical spine with and without contrast | CPT | 72156 | 19 | $2,913.75 | $874.12 | $1,194.64 | $1,194.64 | $2,913.75 |
| MRI lumbar spine with contrast | CPT | 72158 | 19 | $3,347.14 | $1,004.14 | $1,372.33 | $1,372.33 | $3,347.14 |
| CT pelvis without contrast | CPT | 72192 | 19 | $1,601.78 | $480.53 | $656.73 | $656.73 | $1,601.78 |
| CT pelvis with contrast | CPT | 72193 | 19 | $1,872.68 | $561.8 | $767.8 | $767.8 | $1,872.68 |
| Shoulder X-ray | CPT | 73030 | 23 | $1,120.5 | $336.15 | $306.27 | $459.41 | $918.81 |
| Humerus X-ray | CPT | 73060 | 24 | $716 | $214.8 | $293.56 | $413.85 | $716 |
| Hand X-ray 3 views | CPT | 73130 | 24 | $793.5 | $238.05 | $216.89 | $325.34 | $793.5 |
| MRI upper extremity joint without contrast | CPT | 73221 | 19 | $4,184.78 | $1,255.43 | $1,143.84 | $1,715.76 | $4,184.78 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 19 | $3,715.69 | $1,114.71 | $1,523.43 | $1,523.43 | $3,715.69 |
| Knee X-ray 1-2 views | CPT | 73560 | 23 | $813 | $243.9 | $222.22 | $333.33 | $666.66 |
| Ankle X-ray 3 views | CPT | 73610 | 24 | $1,077 | $323.1 | $294.38 | $441.57 | $1,077 |
| MRI lower extremity joint without contrast | CPT | 73721 | 19 | $4,184.78 | $1,255.43 | $1,143.84 | $1,715.76 | $4,184.78 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 19 | $5,467.62 | $1,640.29 | $1,494.48 | $2,241.72 | $5,467.62 |
| CT abdomen without contrast | CPT | 74150 | 19 | $1,217.74 | $365.32 | $499.27 | $499.27 | $1,217.74 |
| CT abdomen with contrast | CPT | 74160 | 19 | $2,174.55 | $652.36 | $891.57 | $891.57 | $2,174.55 |
| CT abdomen with and without contrast | CPT | 74170 | 19 | $2,474.33 | $742.3 | $1,014.48 | $1,014.48 | $2,474.33 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 19 | $3,462.9 | $1,038.87 | $1,419.79 | $1,419.79 | $3,462.9 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 19 | $4,046.96 | $1,214.09 | $1,659.25 | $1,659.25 | $4,046.96 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 19 | $4,650.19 | $1,395.06 | $1,906.58 | $1,906.58 | $4,650.19 |
| MRI abdomen without contrast | CPT | 74181 | 19 | $3,347.14 | $1,004.14 | $1,372.33 | $1,372.33 | $3,347.14 |
| MRI abdomen with and without contrast | CPT | 74183 | 19 | $3,719.63 | $1,115.89 | $1,525.05 | $1,525.05 | $3,719.63 |
| Abdominal ultrasound complete | CPT | 76700 | 19 | $1,543 | $462.9 | $632.63 | $632.63 | $1,543 |
| Abdominal ultrasound limited | CPT | 76705 | 19 | $1,167 | $350.1 | $478.47 | $478.47 | $1,167 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 19 | $952 | $285.6 | $390.32 | $390.32 | $952 |
| Obstetric ultrasound first trimester | CPT | 76801 | 19 | $1,477 | $443.1 | $605.57 | $605.57 | $1,477 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 19 | $1,352 | $405.6 | $554.32 | $554.32 | $1,352 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 19 | $765 | $229.5 | $313.65 | $313.65 | $765 |
| Transvaginal ultrasound | CPT | 76830 | 19 | $1,473 | $441.9 | $603.93 | $603.93 | $1,473 |
| Pelvic ultrasound complete | CPT | 76856 | 19 | $1,477 | $443.1 | $605.57 | $605.57 | $1,477 |
| Scrotal ultrasound | CPT | 76870 | 19 | $1,078 | $323.4 | $441.98 | $441.98 | $1,078 |
| Diagnostic mammography unilateral | CPT | 77065 | 20 | $714 | $214.2 | $249.9 | $292.74 | $928.2 |
| Diagnostic mammography bilateral | CPT | 77066 | 20 | $787 | $236.1 | $275.45 | $322.67 | $1,023.1 |
| Screening mammography bilateral | CPT | 77067 | 20 | $626 | $187.8 | $219.1 | $256.66 | $813.8 |
| EKG tracing only | CPT | 93005 | 22 | $510 | $153 | $209.1 | $255 | $510 |
| Transthoracic echocardiogram complete | CPT | 93306 | 22 | $4,114 | $1,234.2 | $1,686.74 | $2,057 | $4,114 |
| Transthoracic echocardiogram | CPT | 93307 | 21 | $782 | $234.6 | $320.62 | $355.81 | $641.24 |
| Stress echocardiogram | CPT | 93350 | 22 | $5,114 | $1,534.2 | $2,096.74 | $2,557 | $5,114 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 19 | $167.21 | $50.16 | $68.56 | $68.56 | $167.21 |
| General health panel | CPT | 80050 | 11 | $605 | $181.5 | $211.75 | $248.05 | $605 |
| Electrolyte panel | CPT | 80051 | 19 | $134.4 | $40.32 | $55.1 | $55.1 | $134.4 |
| Comprehensive metabolic panel | CPT | 80053 | 18 | $179.81 | $53.94 | $73.72 | $73.72 | $147.44 |
| Lipid panel | CPT | 80061 | 19 | $148.58 | $44.57 | $60.92 | $60.92 | $148.58 |
| Renal function panel | CPT | 80069 | 19 | $179.03 | $53.71 | $73.4 | $73.4 | $179.03 |
| Hepatic function panel | CPT | 80076 | 19 | $163.8 | $49.14 | $67.16 | $67.16 | $163.8 |
| Urinalysis non-automated | CPT | 81002 | 9 | $21 | $6.3 | $8.61 | $8.61 | $21 |
| Urinalysis automated | CPT | 81003 | 19 | $34.65 | $10.39 | $14.21 | $14.21 | $34.65 |
| Glucose quantitative | CPT | 82947 | 19 | $81.38 | $24.41 | $33.37 | $33.37 | $81.38 |
| Hemoglobin A1c | CPT | 83036 | 18 | $73.76 | $22.13 | $30.24 | $30.24 | $60.48 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 18 | $91.88 | $27.56 | $37.67 | $37.67 | $75.34 |
| Complete blood count with automated differential | CPT | 85025 | 18 | $48.04 | $14.41 | $19.7 | $19.7 | $39.39 |
| Complete blood count without differential | CPT | 85027 | 19 | $48.04 | $14.41 | $19.7 | $19.7 | $48.04 |
| Urine culture bacterial | CPT | 87086 | 19 | $60.11 | $18.03 | $24.65 | $24.65 | $60.11 |
| Urine culture identification | CPT | 87088 | 9 | $121.28 | $36.38 | $49.72 | $49.72 | $121.28 |
| Tissue exam by pathologist level IV | CPT | 88305 | 19 | $221.29 | $66.39 | $90.73 | $90.73 | $221.29 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 20 | $1,139 | $341.7 | $466.99 | $466.99 | $1,139 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 18 | $411 | $123.3 | $168.51 | $168.51 | $534.3 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 19 | $1,197 | $359.1 | $490.77 | $490.77 | $1,197 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 19 | $1,714 | $514.2 | $702.74 | $702.74 | $1,714 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 11 | $2,477 | $743.1 | $1,015.57 | $1,015.57 | $2,477 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 19 | $3,303 | $990.9 | $1,354.23 | $1,354.23 | $3,303 |
| Colonoscopy diagnostic | CPT | 45378 | 19 | $2,028 | $608.4 | $831.48 | $831.48 | $2,028 |
| Colonoscopy with biopsy | CPT | 45380 | 19 | $2,648 | $794.4 | $1,085.68 | $1,085.68 | $2,648 |
| Colonoscopy with polyp removal | CPT | 45385 | 19 | $2,503 | $750.9 | $1,026.23 | $1,026.23 | $2,503 |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 21 | $23,554 | $7,066.2 | $9,657.14 | $10,717 | $23,554 |
| PCI with drug-eluting stent | CPT | 92928 | 21 | $39,114 | $11,734 | $16,037 | $17,797 | $39,114 |
| PCI bypass graft | CPT | 92937 | 11 | $67,508 | $20,252 | $27,678 | $27,678 | $67,508 |
| Coronary angiography with cath | CPT | 93455 | 21 | $10,478 | $3,143.4 | $4,295.98 | $4,767.49 | $10,478 |
| Coronary angiography with bypass cath | CPT | 93458 | 21 | $12,292 | $3,687.6 | $5,039.72 | $5,592.86 | $12,292 |