| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $428 | $342.4 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $789 | $631.2 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,376 | $1,100.8 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,137 | $1,709.6 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,099 | $2,479.2 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,281 | $3,424.8 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,563 | $2,050.4 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,902 | $2,321.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,360 | $2,688 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,973 | $2,378.4 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,212 | $2,569.6 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,640 | $3,712 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $438 | $350.4 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $502 | $401.6 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $475 | $380 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,712 | $2,169.6 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,254 | $2,603.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,654 | $2,923.2 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $539 | $431.2 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,820 | $2,256 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,418 | $1,934.4 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,807 | $2,245.6 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,017 | $2,413.6 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,017 | $2,413.6 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,101 | $2,480.8 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,430 | $3,544 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,430 | $3,544 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,262 | $1,809.6 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,099 | $2,479.2 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,036 | $2,428.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,903 | $3,122.4 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,017 | $2,413.6 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,089 | $3,271.2 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,741 | $2,192.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,186 | $2,548.8 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,736 | $2,988.8 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,824 | $3,859.2 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $5,700 | $4,560 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $6,726 | $5,380.8 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,290 | $2,632 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,389 | $3,511.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,488 | $1,190.4 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,199 | $959.2 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $580 | $464 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,121 | $896.8 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $825 | $660 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,225 | $980 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $968 | $774.4 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $664 | $531.2 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $591 | $472.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $328 | $262.4 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,093 | $2,474.4 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $2,661 | $2,128.8 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $220 | $176 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $165 | $132 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $300 | $240 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $229 | $183.2 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $221 | $176.8 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $217 | $173.6 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $62 | $49.6 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $71 | $56.8 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $150 | $120 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $234 | $187.2 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $146 | $116.8 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $119 | $95.2 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $140 | $112 | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $143 | $114.4 | — | — | — |
| preventive |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $5,693 | $4,554.4 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $5,693 | $4,554.4 | — | — | — |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 0 | $27,574 | $22,059 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $53,073 | $42,458 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $16,286 | $13,029 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $8,927 | $7,141.6 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $8,698 | $6,958.4 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $15,720 | $12,576 | — | — | — |