| emergency |
| ED visit level 3 | CPT | 99283 | 0 | $362 | $253.4 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $486 | $340.2 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $655 | $458.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $843 | $590.1 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,220 | $854 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,060 | $1,442 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,221 | $1,554.7 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,470 | $1,729 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,705 | $3,293.5 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $210 | $147 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,816 | $1,271.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,276 | $1,593.2 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,582 | $1,807.4 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $278 | $194.6 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,725 | $1,207.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,695 | $1,186.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,690 | $1,183 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,351 | $1,645.7 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,355 | $1,648.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,756 | $1,929.2 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,100 | $2,870 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,082 | $2,857.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,480 | $1,036 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,130 | $1,491 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $375 | $262.5 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $374 | $261.8 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $750 | $525 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,917 | $2,041.9 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,690 | $2,583 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $410 | $287 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $430 | $301 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,912 | $2,038.4 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,208 | $2,945.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,532 | $1,072.4 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $3,041 | $2,128.7 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,598 | $1,818.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,200 | $1,540 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $3,820 | $2,674 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,308 | $3,015.6 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,273 | $2,291.1 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,804 | $3,362.8 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $697 | $487.9 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $662 | $463.4 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $639 | $447.3 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $661 | $462.7 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $738 | $516.6 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $652 | $456.4 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $612 | $428.4 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $525 | $367.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $350 | $245 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $460 | $322 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $395 | $276.5 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $258 | $180.6 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $86 | $60.2 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $215 | $150.5 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $285 | $199.5 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $373 | $261.1 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $202 | $141.4 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $213 | $149.1 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $100 | $70 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $162 | $113.4 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $144 | $100.8 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $86 | $60.2 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $73 | $51.1 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $24 | $16.8 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $45 | $31.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $100 | $70 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $180 | $126 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $84 | $58.8 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $57 | $39.9 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $72 | $50.4 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $197 | $137.9 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $273 | $191.1 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $395 | $276.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $491 | $343.7 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $132 | $92.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $176 | $123.2 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $242 | $169.4 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $361 | $252.7 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $523 | $366.1 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $551 | $385.7 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $870 | $609 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $987 | $690.9 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $1,159 | $811.3 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $4,805 | $3,363.5 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $4,491 | $3,143.7 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $4,486 | $3,140.2 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $633 | $443.1 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $3,712 | $2,598.4 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,992 | $1,394.4 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $1,768 | $1,237.6 | — | — | — |
