| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $341 | $85.25 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $635.5 | $158.88 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,118 | $279.5 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,880.75 | $470.19 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,776.25 | $694.06 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $3,525 | $881.25 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,301.5 | $575.38 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,570.25 | $642.56 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,570.25 | $642.56 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,061.25 | $515.31 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,531.25 | $632.81 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,111.25 | $527.81 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,525.5 | $881.38 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $348.5 | $87.13 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $557 | $139.25 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $394 | $98.5 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,143.75 | $535.94 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,225.5 | $556.38 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,892.5 | $473.13 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $557 | $139.25 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,757.5 | $689.38 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,757.5 | $689.38 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,757.5 | $689.38 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,180.75 | $795.19 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,828.25 | $707.06 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,828.25 | $707.06 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,319.25 | $829.81 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,524 | $881 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,696.5 | $924.13 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,109 | $527.25 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,278.25 | $569.56 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $1,113.75 | $278.44 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $695.5 | $173.88 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $695.5 | $173.88 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $5,088.5 | $1,272.13 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $4,314 | $1,078.5 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $695.5 | $173.88 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $1,113.75 | $278.44 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $6,615.25 | $1,653.81 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,314 | $1,078.5 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,103 | $525.75 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,027 | $506.75 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,193.25 | $548.31 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,379.75 | $1,094.94 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,304.25 | $1,076.06 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,882.75 | $1,220.69 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,941.5 | $735.38 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,452 | $863 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $964 | $241 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $898.25 | $224.56 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $722.5 | $180.63 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $924 | $231 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $924 | $231 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $871 | $217.75 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $975.5 | $243.88 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $944.75 | $236.19 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $501.5 | $125.38 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,153.25 | $288.31 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $667.25 | $166.81 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $460.25 | $115.06 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $58 | $14.5 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,439 | $609.75 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,581.75 | $395.44 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $220 | $55 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $418.25 | $104.56 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $198 | $49.5 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $207 | $51.75 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $355.5 | $88.88 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $248 | $62 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $36.75 | $9.19 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $46 | $11.5 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $91 | $22.75 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $98 | $24.5 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $125 | $31.25 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $105.25 | $26.31 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $80.75 | $20.19 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $1,139.25 | $284.81 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $738.25 | $184.56 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $272.75 | $68.19 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $352.25 | $88.06 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $477.75 | $119.44 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $636 | $159 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $192 | $48 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $272.75 | $68.19 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $260 | $65 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $352.25 | $88.06 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $477.75 | $119.44 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $4,126.21 | $1,031.55 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $6,796.9 | $1,699.23 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $4,514.22 | $1,128.56 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $9,820.04 | $2,455.01 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,942.3 | $735.58 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $6,035.48 | $1,508.87 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $9,992.96 | $2,498.24 | — | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $37,580 | $9,394.93 | — | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $67,135 | $16,784 | — | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $66,440 | $16,610 | — | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $39,062 | $9,765.41 | — | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $12,919 | $3,229.69 | — | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $27,300 | $6,824.91 | — | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $26,946 | $6,736.51 | — | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $16,586 | $4,146.51 | — | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $24,969 | $6,242.15 | — | — | — | — |
| Open umbilical hernia repair | CPT | 49560 | 0 | $12,656 | $3,164.03 | — | — | — | — |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $13,563 | $3,390.65 | — | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $18,317 | $4,579.2 | — | — | — | — |
| Lap incisional hernia repair | CPT | 49652 | 0 | $44,289 | $11,072 | — | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $25,385 | $6,346.29 | — | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $15,477 | $3,869.32 | — | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $9,957.94 | $2,489.49 | — | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $9,481.53 | $2,370.38 | — | — | — | — |