| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $156.23 | $156.23 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $283.78 | $283.78 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $498.17 | $498.17 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $846.26 | $846.26 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,244.25 | $1,244.25 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,182.29 | $2,182.29 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,304 | $1,304 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,512 | $1,512 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,936 | $1,936 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,512 | $1,512 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,250 | $2,250 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,500 | $2,500 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,750 | $2,750 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $169.95 | $169.95 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $164.54 | $164.54 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $260.64 | $260.64 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,552 | $1,552 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,816 | $1,816 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,464 | $1,464 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,250 | $2,250 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $156.05 | $156.05 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,536 | $1,536 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,536 | $1,536 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,536 | $1,536 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,250 | $2,250 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,250 | $2,250 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,250 | $2,250 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,750 | $2,750 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,750 | $2,750 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,560 | $1,560 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,760 | $1,760 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $149.61 | $149.61 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $134.93 | $134.93 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $136.99 | $136.99 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,250 | $2,250 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,750 | $2,750 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $131.58 | $131.58 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $144.46 | $144.46 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,250 | $2,250 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,750 | $2,750 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,440 | $1,440 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,792 | $1,792 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,240 | $2,240 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,576 | $1,576 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $1,928 | $1,928 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,552 | $2,552 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,250 | $2,250 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,750 | $2,750 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $302.56 | $302.56 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $312.09 | $312.09 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $357 | $357 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $315.18 | $315.18 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $366.75 | $366.75 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $345.25 | $345.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $297.16 | $297.16 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $218.62 | $218.62 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $181.5 | $181.5 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $47.7 | $47.7 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,379.17 | $1,379.17 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,066.25 | $1,066.25 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $255.78 | $255.78 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $293.95 | $293.95 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $550.62 | $550.62 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $167.2 | $167.2 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $258.68 | $258.68 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $151.5 | $151.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $215 | $215 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $136 | $136 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $150.5 | $150.5 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $85.5 | $85.5 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $24 | $24 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $585.9 | $585.9 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $50.5 | $50.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $85.5 | $85.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $120.75 | $120.75 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $105.25 | $105.25 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $98 | $98 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $377.63 | $377.63 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $8,991.25 | $8,991.25 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $3,957.77 | $3,957.77 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $95.58 | $95.58 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $36.04 | $36.04 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $68.82 | $68.82 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $461.06 | $461.06 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,941.22 | $1,941.22 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,271.76 | $2,271.76 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,733.01 | $1,733.01 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,394.73 | $2,394.73 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,234.63 | $2,234.63 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,264.3 | $2,264.3 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,476.81 | $2,476.81 | — | — | — |
| surgery |
| Open appendectomy | CPT | 44950 | 0 | $7,508.89 | $7,508.89 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $11,050 | $11,050 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $11,050 | $11,050 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $13,744 | $13,744 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $11,050 | $11,050 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $4,818.92 | $4,818.92 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $16,575 | $16,575 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $19,265 | $19,265 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $11,050 | $11,050 | — | — | — |