| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $156 | $117 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $282 | $211.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $595 | $446.25 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,252 | $939 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,971 | $1,478.25 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,502 | $1,876.5 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,308 | $981 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,780 | $1,335 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,116 | $1,587 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,780 | $1,335 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $194 | $145.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $268 | $201 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $316 | $237 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $505 | $378.75 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $579 | $434.25 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $505 | $378.75 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,308 | $981 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,780 | $1,335 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,116 | $1,587 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $288 | $216 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $370 | $277.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $452 | $339 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $391 | $293.25 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,308 | $981 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,308 | $981 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,308 | $981 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $189 | $141.75 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $189 | $141.75 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $189 | $141.75 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $268 | $201 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $317 | $237.75 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $317 | $237.75 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,308 | $981 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,780 | $1,335 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $605 | $453.75 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $735 | $551.25 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $605 | $453.75 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $201 | $150.75 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $385 | $288.75 | — | — | — |
| Hip X-ray 2 views | CPT | 73510 | 0 | $303 | $227.25 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $786 | $589.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $605 | $453.75 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $200 | $150 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $383 | $287.25 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,308 | $981 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,780 | $1,335 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,895 | $2,921.25 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,621 | $1,965.75 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,558 | $2,668.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,233 | $3,174.75 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $194 | $145.5 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $336 | $252 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $658 | $493.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,188 | $891 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $658 | $493.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $658 | $493.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,189 | $891.75 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $170 | $127.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $658 | $493.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $658 | $493.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,188 | $891 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $193 | $144.75 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $347 | $260.25 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $347 | $260.25 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $205 | $153.75 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $150 | $112.5 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $55 | $41.25 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,637 | $1,977.75 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,317 | $987.75 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $235 | $176.25 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $287 | $215.25 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $482 | $361.5 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $307 | $230.25 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $405 | $303.75 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $220 | $165 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $166 | $124.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $354 | $265.5 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $160.16 | $120.12 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $151 | $113.25 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $111 | $83.25 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $38 | $28.5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $21 | $15.75 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $34 | $25.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $85 | $63.75 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $147 | $110.25 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $68 | $51 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $87 | $65.25 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $70 | $52.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $125 | $93.75 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $314 | $235.5 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $7,583 | $5,687.25 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,325 | $2,493.75 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $3,868 | $2,901 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $8,547 | $6,410.25 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $3,949 | $2,961.75 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $4,655 | $3,491.25 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $447 | $335.25 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $607 | $455.25 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $862 | $646.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $1,107 | $830.25 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $207 | $155.25 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $581 | $435.75 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $762 | $571.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $1,055 | $791.25 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,412 | $1,059 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,279 | $959.25 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,483 | $1,112.25 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $580 | $435 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $735 | $551.25 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,685 | $1,263.75 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,035 | $1,526.25 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,289 | $1,716.75 | — | — | — |
| surgery |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $4,680 | $3,510 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $6,036 | $4,527 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $6,495 | $4,871.25 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $7,014 | $5,260.5 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $778 | $583.5 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $2,620 | $1,965 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $2,393 | $1,794.75 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $2,993 | $2,244.75 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $3,044 | $2,283 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,723 | $1,292.25 | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $3,234 | $2,425.5 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $4,170 | $3,127.5 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $3,481 | $2,610.75 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $4,087 | $3,065.25 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $2,709 | $2,031.75 | — | — | — |
