| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $341 | $170.5 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $395 | $197.5 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $173 | $86.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $228 | $114 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $336 | $168 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $322 | $161 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $416 | $208 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $559 | $279.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,034 | $517 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,494 | $747 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,060 | $1,030 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,020 | $1,010 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,698 | $849 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,446 | $1,223 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,774 | $887 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,448 | $1,724 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,953 | $1,476.5 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,486 | $2,243 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $792 | $396 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $363 | $181.5 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,910 | $955 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,214 | $1,107 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $141 | $70.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $163 | $81.5 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $445 | $222.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,211 | $1,105.5 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,117 | $1,058.5 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,188 | $1,094 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,496 | $1,748 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,496 | $1,748 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,496 | $1,748 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,821 | $1,910.5 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,436 | $2,218 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,478 | $2,239 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,898 | $949 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,012 | $1,006 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $381 | $190.5 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $377 | $188.5 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $387 | $193.5 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,077 | $1,538.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $243 | $121.5 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $345 | $172.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $396 | $198 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,716 | $1,858 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $4,486 | $2,243 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,975 | $987.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,318 | $1,159 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,755 | $1,377.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $3,058 | $1,529 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,039 | $2,019.5 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,034 | $2,517 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,716 | $1,858 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,473 | $2,236.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,045 | $522.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $746 | $373 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $922 | $461 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $706 | $353 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $114 | $57 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $221 | $110.5 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $895 | $447.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $842 | $421 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $965 | $482.5 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $92 | $46 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $114 | $57 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $391 | $195.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $430 | $215 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $20 | $10 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,423 | $1,211.5 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $105 | $52.5 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $165 | $82.5 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $229 | $114.5 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $288 | $144 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $418 | $209 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $198 | $99 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $275 | $137.5 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $78 | $39 | — | — | — |
| General health panel | CPT | 80050 | 0 | $429 | $214.5 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $125 | $62.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $10 | $5 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $45 | $22.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $85 | $42.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $459 | $229.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $169 | $84.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $104 | $52 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $143 | $71.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $42 | $21 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $62 | $31 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $250 | $125 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $72 | $36 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,406 | $2,703 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $1,784 | $892 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,406 | $1,203 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $6,048 | $3,024 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,035 | $1,017.5 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $3,019 | $1,509.5 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $169 | $84.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $198 | $99 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $352 | $176 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $439 | $219.5 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $169 | $84.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $85 | $42.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $169 | $84.5 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $247 | $123.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $348 | $174 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $269 | $134.5 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $301 | $150.5 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $130 | $65 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $162 | $81 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $457 | $228.5 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $434 | $217 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $546 | $273 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $3,159 | $1,579.5 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $2,508 | $1,254 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $2,822 | $1,411 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $2,818 | $1,409 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $3,094 | $1,547 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $3,830 | $1,915 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $363 | $181.5 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $2,363 | $1,181.5 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,239 | $619.5 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $2,153 | $1,076.5 | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | $4,315 | $2,157.5 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $1,478 | $739 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $1,405 | $702.5 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $1,537 | $768.5 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $1,667 | $833.5 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $1,026 | $513 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $2,280 | $1,140 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $1,813 | $906.5 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $1,923 | $961.5 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $2,147 | $1,073.5 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $1,435 | $717.5 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $1,519 | $759.5 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $1,113 | $556.5 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $183 | $91.5 | — | — | — |