| behavioral |
| Psychiatric eval with medical services | CPT | 90792 | 10 | $410 | $287 | $65 | $80 | 0.46× | $141.28 |
| Psychotherapy 30 minutes | CPT | 90832 | 11 | $207 | $144.9 | $65 | $80 | 0.54× | $141.28 |
| emergency |
| ED visit level 1 | CPT | 99281 | 11 | $278 | $194.6 | $55 | $76.41 | 0.55× | $335 |
| ED visit level 2 | CPT | 99282 | 11 | $278 | $194.6 | $55 | $80 | 0.34× | $525 |
| ED visit level 3 | CPT | 99283 | 11 | $486 | $340.2 | $55 | $80 | 0.20× | $605 |
| ED visit level 4 | CPT | 99284 | 11 | $854 | $597.8 | $55 | $80 | 0.12× | $949 |
| ED visit level 5 | CPT | 99285 | 11 | $854 | $597.8 | $55 | $80 | 0.08× | $1,125 |
| Critical care, first hour | CPT | 99291 | 11 | $2,457 | $1,719.9 | $55 | $80 | 0.07× | $1,228 |
| imaging |
| CT head without contrast | CPT | 70450 | 11 | $1,773 | $1,241.1 | $65 | $80 | 0.39× | $850 |
| CT head with contrast | CPT | 70460 | 11 | $2,002 | $1,401.4 | $65 | $80 | 0.34× | $850 |
| CT head with and without contrast | CPT | 70470 | 11 | $2,266 | $1,586.2 | $65 | $80 | 0.30× | $850 |
| CT neck with contrast | CPT | 70491 | 11 | $758 | $530.6 | $65 | $80 | 0.29× | $850 |
| CT chest without contrast | CPT | 71250 | 11 | $1,320 | $924 | $65 | $80 | 0.37× | $850 |
| CT chest with contrast | CPT | 71260 | 11 | $2,053 | $1,437.1 | $65 | $80 | 0.28× | $850 |
| CT chest with and without contrast | CPT | 71270 | 11 | $2,747 | $1,922.9 | $65 | $80 | 0.27× | $850 |
| CT cervical spine without contrast | CPT | 72125 | 11 | $2,143 | $1,500.1 | $65 | $80 | 0.40× | $850 |
| CT thoracic spine without contrast | CPT | 72128 | 11 | $1,560 | $1,092 | $65 | $80 | 0.40× | $850 |
| CT lumbar spine without contrast | CPT | 72131 | 11 | $1,560 | $1,092 | $65 | $80 | 0.39× | $850 |
| CT pelvis without contrast | CPT | 72192 | 11 | $1,560 | $1,092 | $65 | $80 | 0.40× | $850 |
| CT pelvis with contrast | CPT | 72193 | 11 | $2,341 | $1,638.7 | $65 | $80 | 0.28× | $850 |
| MRI lower extremity joint without contrast | CPT | 73721 | 11 | $2,027 | $1,418.9 | $65 | $80 | 0.17× | $935 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 11 | $3,644 | $2,550.8 | $65 | $80 | 0.13× | $935 |
| CT abdomen without contrast | CPT | 74150 | 11 | $1,360 | $952 | $65 | $80 | 0.43× | $850 |
| CT abdomen with contrast | CPT | 74160 | 11 | $1,887.75 | $1,321.43 | $65 | $80 | 0.28× | $850 |
| CT abdomen with and without contrast | CPT | 74170 | 11 | $2,232.25 | $1,562.58 | $65 | $80 | 0.24× | $850 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 11 | $2,151 | $1,505.7 | $65 | $80 | 0.22× | $850 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 11 | $2,251 | $1,575.7 | $65 | $80 | 0.15× | $850 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 11 | $2,951 | $2,065.7 | $65 | $80 | 0.14× | $850 |
| Abdominal ultrasound limited | CPT | 76705 | 11 | $286 | $200.2 | $65 | $80 | 0.55× | $275 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 11 | $657 | $459.9 | $65 | $80 | 0.52× | $275 |
| EKG tracing only | CPT | 93005 | 11 | $116 | $81.2 | $55.74 | $80 | 0.68× | $150 |
| EKG interpretation only | CPT | 93010 | 9 | $32 | $22.4 | $65 | $80 | 4.4× | $100 |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 9 | $240 | $168 | $65 | $80 | 0.86× | $100 |
| Initial hospital care, moderate complexity | CPT | 99222 | 9 | $572 | $400.4 | $65 | $80 | 0.47× | $100 |
| Initial hospital care, high complexity | CPT | 99223 | 9 | $716 | $501.2 | $65 | $80 | 0.36× | $100 |
| Hospital discharge, <30 min | CPT | 99238 | 9 | $287 | $200.9 | $65 | $80 | 0.93× | $100 |
| Hospital discharge, >30 min | CPT | 99239 | 9 | $378 | $264.6 | $65 | $80 | 0.66× | $100 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 11 | $56 | $39.2 | $7.61 | $70 | 2.2× | $100 |
| General health panel | CPT | 80050 | 10 | $274 | $191.8 | $50 | $75 | 0.70× | $100 |
| Electrolyte panel | CPT | 80051 | 11 | $55 | $38.5 | $6.31 | $70 | 2.9× | $100 |
| Comprehensive metabolic panel | CPT | 80053 | 11 | $82 | $57.4 | $9.5 | $70 | 1.6× | $100 |
| Lipid panel | CPT | 80061 | 11 | $103 | $72.1 | $12.05 | $70 | 1.8× | $100 |
| Renal function panel | CPT | 80069 | 11 | $67 | $46.9 | $7.81 | $70 | 2.6× | $100 |
| Hepatic function panel | CPT | 80076 | 11 | $63 | $44.1 | $7.35 | $70 | 2.6× | $100 |
| Urinalysis automated | CPT | 81003 | 11 | $19 | $13.3 | $2.03 | $70 | 5.0× | $100 |
| Glucose quantitative | CPT | 82947 | 11 | $30 | $21 | $3.54 | $70 | 4.0× | $100 |
| Hemoglobin A1c | CPT | 83036 | 11 | $75 | $52.5 | $8.74 | $70 | 2.6× | $100 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 11 | $132 | $92.4 | $15.12 | $70 | 1.5× | $100 |
| Complete blood count with automated differential | CPT | 85025 | 11 | $60 | $42 | $6.99 | $70 | 2.6× | $100 |
| Urine culture bacterial | CPT | 87086 | 11 | $53 | $37.1 | $7.26 | $70 | 3.0× | $100 |
| Tissue exam by pathologist level IV | CPT | 88305 | 11 | $381 | $266.7 | $48.62 | $70 | 0.68× | $100 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 9 | $296 | $207.2 | $65 | $80 | 0.43× | $172.73 |
| Vaginal delivery only | CPT | 59409 | 11 | $4,436 | $3,105.2 | $65 | $80 | 0.04× | $2,741.71 |
| C-section delivery only | CPT | 59514 | 9 | $4,176 | $2,923.2 | $65 | $80 | 0.08× | $100 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 9 | $209 | $146.3 | $65 | $80 | 0.93× | $263.08 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 9 | $288 | $201.6 | $65 | $80 | 0.65× | $263.08 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 9 | $434 | $303.8 | $65 | $80 | 0.46× | $263.08 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 9 | $557 | $389.9 | $65 | $80 | 0.36× | $263.08 |
| Office visit, established patient, 5 min | CPT | 99211 | 9 | $176 | $123.2 | $65 | $80 | 1.2× | $263.08 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 9 | $209 | $146.3 | $65 | $80 | 1.0× | $263.08 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 9 | $197 | $137.9 | $23.94 | $80 | 0.70× | $263.08 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 9 | $363 | $254.1 | $47.68 | $80 | 0.52× | $263.08 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 9 | $464 | $324.8 | $65 | $80 | 0.42× | $263.08 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 9 | $1,750 | $1,225 | $65 | $80 | 0.09× | $800.48 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 9 | $1,750 | $1,225 | $65 | $80 | 0.08× | $800.48 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 9 | $291 | $203.7 | $65 | $80 | 0.09× | $805.84 |
| Colonoscopy diagnostic | CPT | 45378 | 9 | $1,858 | $1,300.6 | $65 | $80 | 0.09× | $805.84 |
| Colonoscopy with biopsy | CPT | 45380 | 9 | $1,858 | $1,300.6 | $65 | $80 | 0.07× | $1,050.07 |
| Colonoscopy with polyp removal | CPT | 45385 | 9 | $1,849 | $1,294.3 | $65 | $80 | 0.07× | $1,050.07 |
| surgery |
| Laparoscopic cholecystectomy | CPT | 47562 | 9 | $9,260 | $6,482 | $65 | $80 | 0.05× | $5,054.12 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 9 | $9,260 | $6,482 | $65 | $80 | 0.04× | $5,054.12 |
| Open umbilical hernia repair | CPT | 49560 | 9 | $6,150 | $4,305 | $65 | $80 | 0.04× | $100 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 9 | $6,153 | $4,307.1 | $65 | $80 | 0.06× | $100 |
| Total abdominal hysterectomy | CPT | 58150 | 10 | $5,645 | $3,951.5 | $65 | $80 | 0.08× | $100 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 9 | $2,868 | $2,007.6 | $65 | $80 | 0.04× | $8,811.77 |
| Lap salpingo-oophorectomy | CPT | 58661 | 9 | $9,260 | $6,482 | $65 | $80 | 0.04× | $5,054.12 |