| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $348 | $104.4 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $640 | $192 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $1,117 | $335.1 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,759 | $527.7 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $2,523 | $756.9 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,819 | $845.64 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $785 | $235.5 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,276 | $382.8 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,276 | $382.8 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,276 | $382.8 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,673 | $801.9 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,673 | $801.9 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $479 | $143.7 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $479 | $143.7 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $479 | $143.7 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $785 | $235.5 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,276 | $382.8 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,276 | $382.8 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $4,766 | $1,429.8 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,673 | $801.9 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $672 | $201.6 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $785 | $235.5 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $785 | $235.5 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $785 | $235.5 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,673 | $801.9 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,673 | $801.9 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,673 | $801.9 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $785 | $235.5 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,276 | $382.8 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $479 | $143.7 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $479 | $143.7 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $479 | $143.7 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,673 | $801.9 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $479 | $143.7 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $479 | $143.7 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,673 | $801.9 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $785 | $235.5 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,276 | $382.8 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $1,276 | $382.8 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,631 | $489.3 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,673 | $801.9 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,673 | $801.9 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,631 | $489.3 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,673 | $801.9 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $785 | $235.5 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $785 | $235.5 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $785 | $235.5 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $785 | $235.5 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $785 | $235.5 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,631 | $489.3 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $785 | $235.5 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $785 | $235.5 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $785 | $235.5 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $339 | $101.7 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $432 | $129.6 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $358 | $107.4 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $220 | $66 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $159 | $47.84 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,371 | $1,011.3 | — | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $310 | $92.99 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $418 | $125.39 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $620 | $185.98 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $224 | $67.07 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $329 | $98.82 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $51 | $15.3 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $42 | $12.6 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $63 | $18.9 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $80 | $24 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $52 | $15.6 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $49 | $14.7 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $14 | $4.2 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $24 | $7.2 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $58 | $17.4 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $101 | $30.3 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $47 | $14.1 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $39 | $11.7 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $48 | $14.4 | — | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $12,491 | $3,747.3 | — | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $348 | $104.4 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $46 | $13.8 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $63 | $18.9 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $63 | $18.9 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $69 | $20.7 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $280 | $84.09 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $43 | $12.9 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $54 | $16.2 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $62 | $18.6 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $62 | $18.6 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $137 | $41.01 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $420 | $125.91 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,940 | $882 | — | — | — | — |