| emergency |
| ED visit level 1 | CPT | 99281 | 4 | $212 | $191 | $70 | $125 | $235 |
| ED visit level 2 | CPT | 99282 | 4 | $353 | $318 | $94 | $192.5 | $392 |
| ED visit level 3 | CPT | 99283 | 4 | $549 | $494 | $324 | $324 | $609 |
| ED visit level 4 | CPT | 99284 | 4 | $818 | $736 | $182 | $412.5 | $907 |
| ED visit level 5 | CPT | 99285 | 4 | $1,004 | $904 | $592 | $592 | $1,114 |
| Critical care, first hour | CPT | 99291 | 4 | $1,772 | $1,595 | $374 | $941 | $1,966 |
| imaging |
| CT head without contrast | CPT | 70450 | 4 | $2,136 | $1,922 | $1,260 | $1,260 | $2,369 |
| CT head with contrast | CPT | 70460 | 4 | $2,330 | $2,097 | $1,375 | $1,375 | $2,584 |
| CT head with and without contrast | CPT | 70470 | 4 | $2,366 | $2,129 | $1,396 | $1,396 | $2,624 |
| CT neck with contrast | CPT | 70491 | 4 | $2,607 | $2,346 | $1,538 | $1,538 | $2,892 |
| MRI brain without contrast | CPT | 70551 | 4 | $3,774 | $3,397 | $2,227 | $2,227 | $4,186 |
| MRI brain with contrast | CPT | 70552 | 4 | $3,889 | $3,500 | $2,295 | $2,295 | $4,314 |
| MRI brain with and without contrast | CPT | 70553 | 4 | $4,015 | $3,614 | $2,369 | $2,369 | $4,453 |
| Chest X-ray single view | CPT | 71045 | 4 | $289 | $260 | $171 | $171 | $321 |
| Chest X-ray 2 views | CPT | 71046 | 4 | $363 | $327 | $214 | $214 | $403 |
| CT chest without contrast | CPT | 71250 | 4 | $2,413 | $2,172 | $1,424 | $1,424 | $2,676 |
| CT chest with contrast | CPT | 71260 | 4 | $2,782 | $2,504 | $1,641 | $1,641 | $3,086 |
| CT chest with and without contrast | CPT | 71270 | 4 | $3,130 | $2,817 | $1,847 | $1,847 | $3,472 |
| MRI chest without contrast | CPT | 71550 | 4 | $2,620 | $2,358 | $1,546 | $1,546 | $2,906 |
| MRI chest with contrast | CPT | 71551 | 4 | $2,966 | $2,669 | $1,750 | $1,750 | $3,290 |
| MRI chest with and without contrast | CPT | 71552 | 4 | $3,818 | $3,436 | $2,253 | $2,253 | $4,235 |
| Lumbosacral spine X-ray | CPT | 72100 | 4 | $444 | $400 | $262 | $262 | $492 |
| CT cervical spine without contrast | CPT | 72125 | 4 | $2,618 | $2,356 | $1,545 | $1,545 | $2,904 |
| CT thoracic spine without contrast | CPT | 72128 | 4 | $2,563 | $2,307 | $1,512 | $1,512 | $2,843 |
| CT lumbar spine without contrast | CPT | 72131 | 4 | $2,563 | $2,307 | $1,512 | $1,512 | $2,843 |
| MRI cervical spine without contrast | CPT | 72141 | 4 | $3,678 | $3,310 | $2,170 | $2,170 | $4,080 |
| MRI thoracic spine without contrast | CPT | 72146 | 4 | $3,590 | $3,231 | $2,118 | $2,118 | $3,982 |
| MRI lumbar spine without contrast | CPT | 72148 | 4 | $3,535 | $3,182 | $2,086 | $2,086 | $3,921 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 4 | $3,305 | $2,975 | $1,950 | $1,950 | $3,666 |
| MRI cervical spine with and without contrast | CPT | 72156 | 4 | $4,448 | $4,003 | $2,624 | $2,624 | $4,934 |
| MRI lumbar spine with contrast | CPT | 72158 | 4 | $4,189 | $3,770 | $2,472 | $2,472 | $4,646 |
| CT pelvis without contrast | CPT | 72192 | 4 | $2,382 | $2,144 | $1,405 | $1,405 | $2,642 |
| CT pelvis with contrast | CPT | 72193 | 4 | $2,825 | $2,543 | $1,667 | $1,667 | $3,133 |
| Shoulder X-ray | CPT | 73030 | 4 | $371 | $334 | $219 | $219 | $412 |
| Humerus X-ray | CPT | 73060 | 4 | $317 | $285 | $187 | $187 | $352 |
| Hand X-ray 3 views | CPT | 73130 | 4 | $346 | $311 | $204 | $204 | $384 |
| MRI upper extremity joint without contrast | CPT | 73221 | 4 | $2,735 | $2,462 | $1,614 | $1,614 | $3,034 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 4 | $3,943 | $3,549 | $2,326 | $2,326 | $4,374 |
| Knee X-ray 1-2 views | CPT | 73560 | 4 | $434 | $391 | $195 | $256 | $481 |
| Ankle X-ray 3 views | CPT | 73610 | 4 | $470 | $423 | $208 | $277 | $521 |
| MRI lower extremity joint without contrast | CPT | 73721 | 4 | $2,753 | $2,478 | $1,624 | $1,624 | $3,054 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 4 | $3,841 | $3,457 | $2,266 | $2,266 | $4,260 |
| CT abdomen without contrast | CPT | 74150 | 4 | $2,374 | $2,137 | $1,401 | $1,401 | $2,633 |
| CT abdomen with contrast | CPT | 74160 | 4 | $2,836 | $2,552 | $1,673 | $1,673 | $3,146 |
| CT abdomen with and without contrast | CPT | 74170 | 4 | $3,062 | $2,756 | $1,807 | $1,807 | $3,396 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 4 | $4,166 | $3,749 | $2,458 | $2,458 | $4,621 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 4 | $4,866 | $4,379 | $2,871 | $2,871 | $5,397 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 4 | $5,777 | $5,199 | $3,408 | $3,408 | $6,408 |
| MRI abdomen without contrast | CPT | 74181 | 4 | $3,416 | $3,074 | $2,015 | $2,015 | $3,789 |
| MRI abdomen with and without contrast | CPT | 74183 | 4 | $4,487 | $4,038 | $2,647 | $2,647 | $4,977 |
| Abdominal ultrasound complete | CPT | 76700 | 4 | $914 | $823 | $539 | $539 | $1,014 |
| Abdominal ultrasound limited | CPT | 76705 | 4 | $722 | $650 | $426 | $426 | $801 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 4 | $866 | $779 | $511 | $511 | $961 |
| Obstetric ultrasound first trimester | CPT | 76801 | 4 | $691 | $622 | $408 | $408 | $766 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 4 | $765 | $689 | $451 | $451 | $849 |
| Transvaginal ultrasound | CPT | 76830 | 4 | $665 | $599 | $392 | $392 | $738 |
| Pelvic ultrasound complete | CPT | 76856 | 4 | $858 | $772 | $506 | $506 | $952 |
| Scrotal ultrasound | CPT | 76870 | 4 | $721 | $649 | $425 | $425 | $800 |
| EKG complete | CPT | 93000 | 4 | $80 | $72 | $47 | $47 | $89 |
| EKG tracing only | CPT | 93005 | 4 | $327 | $294 | $26 | $121 | $363 |
| EKG interpretation only | CPT | 93010 | 4 | $40 | $36 | $24 | $24 | $44 |
| Transthoracic echocardiogram complete | CPT | 93306 | 4 | $2,324 | $2,092 | $1,371 | $1,371 | $2,578 |
| Transthoracic echocardiogram | CPT | 93307 | 4 | $1,904 | $1,714 | $1,123 | $1,123 | $2,112 |
| Stress echocardiogram | CPT | 93350 | 4 | $1,587 | $1,428 | $936 | $936 | $1,760 |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 4 | $234 | $211 | $138 | $138 | $260 |
| Initial hospital care, moderate complexity | CPT | 99222 | 4 | $323 | $291 | $191 | $191 | $358 |
| Initial hospital care, high complexity | CPT | 99223 | 4 | $470 | $423 | $277 | $277 | $521 |
| Hospital discharge, <30 min | CPT | 99238 | 4 | $222 | $200 | $131 | $131 | $246 |
| Hospital discharge, >30 min | CPT | 99239 | 4 | $250 | $225 | $148 | $148 | $277 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 4 | $161 | $145 | $27 | $73 | $179 |
| General health panel | CPT | 80050 | 4 | $527 | $474 | $91 | $241.5 | $585 |
| Electrolyte panel | CPT | 80051 | 4 | $119 | $107 | $70 | $70 | $132 |
| Comprehensive metabolic panel | CPT | 80053 | 4 | $307 | $276 | $32 | $120.5 | $341 |
| Lipid panel | CPT | 80061 | 4 | $136 | $122 | $42 | $80 | $151 |
| Renal function panel | CPT | 80069 | 4 | $208 | $187 | $123 | $123 | $231 |
| Hepatic function panel | CPT | 80076 | 4 | $153 | $138 | $27 | $70.5 | $170 |
| Urinalysis non-automated | CPT | 81002 | 4 | $33 | $30 | $15 | $19 | $37 |
| Urinalysis automated | CPT | 81003 | 4 | $44 | $40 | $6 | $19 | $49 |
| Glucose quantitative | CPT | 82947 | 4 | $60 | $54 | $18 | $34 | $67 |
| Hemoglobin A1c | CPT | 83036 | 4 | $90 | $81 | $53 | $53 | $100 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 4 | $133 | $120 | $61 | $78 | $148 |
| Complete blood count with automated differential | CPT | 85025 | 4 | $108 | $97 | $17 | $48 | $120 |
| Complete blood count without differential | CPT | 85027 | 4 | $84 | $76 | $50 | $50 | $93 |
| Urine culture bacterial | CPT | 87086 | 4 | $98 | $88 | $27 | $54.5 | $109 |
| Urine culture identification | CPT | 87088 | 4 | $123 | $111 | $44 | $73 | $136 |
| Tissue exam by pathologist level IV | CPT | 88305 | 4 | $212 | $191 | $125 | $125 | $235 |
| maternity |
| Routine obstetric care with C-section | CPT | 59510 | 4 | $5,432 | $4,889 | $3,205 | $3,205 | $6,025 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 4 | $156 | $140 | $53 | $92 | $173 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 4 | $226 | $203 | $133 | $133 | $251 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 4 | $378 | $340 | $223 | $223 | $419 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 4 | $477 | $429 | $281 | $281 | $529 |
| Office visit, established patient, 5 min | CPT | 99211 | 4 | $416 | $374 | $32 | $72.5 | $461 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 4 | $99 | $89 | $50 | $58 | $110 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 4 | $163 | $147 | $96 | $96 | $181 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 4 | $241 | $217 | $65 | $140 | $267 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 4 | $336 | $302 | $196 | $198 | $373 |
| surgery |
| Open umbilical hernia repair | CPT | 49560 | 4 | $2,044 | $1,840 | $1,206 | $1,206 | $2,267 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 4 | $1,241 | $1,117 | $732 | $732 | $1,377 |