| behavioral |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $498 | $199.2 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $660 | $264 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $988 | $395.2 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $185 | $74 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $274 | $109.6 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $370 | $148 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $515 | $206 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $957 | $382.8 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,517 | $606.8 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,284 | $513.6 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,624 | $649.6 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,840 | $736 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,749 | $699.6 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,977 | $790.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,242 | $896.8 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,905 | $1,562 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $177 | $70.8 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $254 | $101.6 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $331 | $132.4 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,558 | $623.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,057 | $822.8 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,362 | $944.8 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,940 | $776 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,168 | $1,267.2 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $334 | $133.6 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,634 | $653.6 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,634 | $653.6 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,323 | $529.2 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,977 | $790.8 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,046 | $818.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,046 | $818.4 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,640 | $1,056 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,934 | $1,573.6 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $5,361 | $2,144.4 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,376 | $550.4 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,661 | $664.4 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $251 | $100.4 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $298 | $119.2 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $229 | $91.6 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,408 | $1,363.2 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,235 | $1,294 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $261 | $104.4 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $233 | $93.2 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,874 | $749.6 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,899 | $1,159.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,323 | $529.2 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,852 | $740.8 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,189 | $875.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,820 | $1,128 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,054 | $1,621.6 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,716 | $1,886.4 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,977 | $790.8 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,408 | $1,363.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $661 | $264.4 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $485 | $194 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $537 | $214.8 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $508 | $203.2 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $516 | $206.4 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $506 | $202.4 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $460 | $184 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $315 | $126 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $539 | $215.6 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $575 | $230 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $217 | $86.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $167 | $66.8 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $29 | $11.6 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,948 | $779.2 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $952 | $380.8 | — | — | — |
| inpatient |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 0 | $15,224 | $6,089.68 | — | — | — |
| COPD w MCC | MS-DRG | 190 | 0 | $12,973 | $5,189.36 | — | — | — |
| COPD w CC | MS-DRG | 191 | 0 | $7,761.79 | $3,104.72 | — | — | — |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $10,753 | $4,301.07 | — | — | — |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 0 | $8,720.65 | $3,488.26 | — | — | — |
| Heart failure & shock w MCC | MS-DRG | 291 | 0 | $11,691 | $4,676.4 | — | — | — |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 0 | $8,223.7 | $3,289.48 | — | — | — |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 0 | $8,262.8 | $3,305.12 | — | — | — |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 0 | $8,376.94 | $3,350.78 | — | — | — |
| Kidney/UTI w MCC | MS-DRG | 689 | 0 | $10,002 | $4,000.75 | — | — | — |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 0 | $10,522 | $4,208.87 | — | — | — |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 0 | $11,508 | $4,603.18 | — | — | — |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 0 | $21,430 | $8,571.96 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $110 | $44 | — | — | — |
| General health panel | CPT | 80050 | 0 | $274 | $109.6 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $80 | $32 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $118 | $47.2 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $80 | $32 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $184 | $73.6 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $153 | $61.2 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $14 | $5.6 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $36 | $14.4 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $36 | $14.4 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $75 | $30 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $106 | $42.4 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $75 | $30 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $46 | $18.4 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $73 | $29.2 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $53 | $21.2 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $222 | $88.8 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $251 | $100.4 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $303 | $121.2 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $383 | $153.2 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $472 | $188.8 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $105 | $42 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $141 | $56.4 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $162 | $64.8 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $193 | $77.2 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $229 | $91.6 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,801.82 | $1,120.73 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,814.49 | $1,125.8 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $3,539.6 | $1,415.84 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,758 | $703.2 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,684.02 | $1,073.61 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,845.19 | $1,138.07 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,937.69 | $1,175.07 | — | — | — |
| surgery |
| Open appendectomy | CPT | 44950 | 0 | $5,282 | $2,112.8 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $5,316 | $2,126.4 | — | — | — |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 0 | $237,972 | $95,189 | — | — | — |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 0 | $138,669 | $55,467 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $5,316 | $2,126.4 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $5,452 | $2,180.8 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $5,156 | $2,062.4 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $5,429 | $2,171.6 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $7,811 | $3,124.4 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $5,316 | $2,126.4 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $5,283 | $2,113.2 | — | — | — |
