| emergency |
| ED visit level 1 | CPT | 99281 | 5 | $223 | $167 | $156 | $201 | $234 |
| ED visit level 2 | CPT | 99282 | 5 | $403 | $302 | $282 | $363 | $423 |
| ED visit level 3 | CPT | 99283 | 5 | $710 | $533 | $497 | $639 | $745 |
| ED visit level 4 | CPT | 99284 | 5 | $1,116 | $837 | $780 | $1,003.5 | $1,172 |
| ED visit level 5 | CPT | 99285 | 5 | $1,600 | $1,200 | $1,120 | $1,440 | $1,680 |
| Critical care, first hour | CPT | 99291 | 5 | $2,282 | $1,712 | $1,596 | $2,053 | $2,396 |
| imaging |
| CT head without contrast | CPT | 70450 | 5 | $780 | $585 | $546 | $702 | $819 |
| CT head with contrast | CPT | 70460 | 5 | $812 | $609 | $568 | $731 | $853 |
| CT head with and without contrast | CPT | 70470 | 5 | $962 | $722 | $673 | $866 | $1,010 |
| CT neck with contrast | CPT | 70491 | 5 | $812 | $609 | $568 | $731 | $853 |
| MRI brain without contrast | CPT | 70551 | 5 | $1,767 | $1,325 | $1,237 | $1,590 | $1,855 |
| MRI brain with contrast | CPT | 70552 | 5 | $2,019 | $1,514 | $1,413 | $1,817 | $2,120 |
| MRI brain with and without contrast | CPT | 70553 | 5 | $3,927 | $2,945 | $2,749 | $3,534 | $4,123 |
| Chest X-ray single view | CPT | 71045 | 5 | $248 | $186 | $174 | $223 | $260 |
| Chest X-ray 2 views | CPT | 71046 | 5 | $248 | $186 | $174 | $223 | $260 |
| CT chest without contrast | CPT | 71250 | 5 | $953 | $715 | $667 | $858 | $1,001 |
| CT chest with contrast | CPT | 71260 | 5 | $1,127 | $845 | $789 | $1,014 | $1,183 |
| CT chest with and without contrast | CPT | 71270 | 5 | $1,225 | $919 | $858 | $1,103 | $1,286 |
| MRI chest without contrast | CPT | 71550 | 5 | $1,386 | $1,040 | $970 | $1,247 | $1,455 |
| MRI chest with contrast | CPT | 71551 | 5 | $2,193 | $1,645 | $1,535 | $1,974 | $2,303 |
| MRI chest with and without contrast | CPT | 71552 | 5 | $2,886 | $2,165 | $2,020 | $2,597 | $3,030 |
| Lumbosacral spine X-ray | CPT | 72100 | 5 | $334 | $251 | $234 | $301 | $351 |
| CT cervical spine without contrast | CPT | 72125 | 5 | $953 | $715 | $667 | $858 | $1,001 |
| CT thoracic spine without contrast | CPT | 72128 | 5 | $953 | $715 | $667 | $858 | $1,001 |
| CT lumbar spine without contrast | CPT | 72131 | 5 | $953 | $715 | $667 | $858 | $1,001 |
| MRI cervical spine without contrast | CPT | 72141 | 5 | $1,767 | $1,325 | $1,237 | $1,590 | $1,855 |
| MRI thoracic spine without contrast | CPT | 72146 | 5 | $1,964 | $1,473 | $1,375 | $1,768 | $2,062 |
| MRI lumbar spine without contrast | CPT | 72148 | 5 | $1,964 | $1,473 | $1,375 | $1,768 | $2,062 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 5 | $1,689 | $1,267 | $1,182 | $1,520 | $1,773 |
| MRI cervical spine with and without contrast | CPT | 72156 | 5 | $3,317 | $2,488 | $2,322 | $2,985 | $3,483 |
| MRI lumbar spine with contrast | CPT | 72158 | 5 | $3,740 | $2,805 | $2,618 | $3,366 | $3,927 |
| CT pelvis without contrast | CPT | 72192 | 5 | $908 | $681 | $636 | $817 | $953 |
| CT pelvis with contrast | CPT | 72193 | 5 | $950 | $713 | $665 | $855 | $998 |
| Shoulder X-ray | CPT | 73030 | 5 | $284 | $213 | $189 | $249.5 | $298 |
| Humerus X-ray | CPT | 73060 | 5 | $270 | $203 | $174 | $229.5 | $284 |
| Hand X-ray 3 views | CPT | 73130 | 5 | $270 | $203 | $174 | $229.5 | $284 |
| MRI upper extremity joint without contrast | CPT | 73221 | 5 | $1,767 | $1,325 | $1,237 | $1,590 | $1,855 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 5 | $2,892 | $2,169 | $2,024 | $2,603 | $3,037 |
| Knee X-ray 1-2 views | CPT | 73560 | 5 | $270 | $203 | $174 | $229.5 | $284 |
| Ankle X-ray 3 views | CPT | 73610 | 5 | $270 | $203 | $174 | $229.5 | $284 |
| MRI lower extremity joint without contrast | CPT | 73721 | 5 | $1,573 | $1,180 | $1,101 | $1,416 | $1,652 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 5 | $2,892 | $2,169 | $2,024 | $2,603 | $3,037 |
| CT abdomen without contrast | CPT | 74150 | 5 | $880 | $660 | $616 | $792 | $924 |
| CT abdomen with contrast | CPT | 74160 | 5 | $1,045 | $784 | $732 | $941 | $1,097 |
| CT abdomen with and without contrast | CPT | 74170 | 5 | $1,200 | $900 | $840 | $1,080 | $1,260 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 5 | $1,130 | $848 | $704 | $930 | $1,187 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 5 | $1,155 | $866 | $809 | $1,040 | $1,213 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 5 | $1,485 | $1,114 | $1,040 | $1,337 | $1,559 |
| MRI abdomen without contrast | CPT | 74181 | 5 | $1,386 | $1,040 | $970 | $1,247 | $1,455 |
| MRI abdomen with and without contrast | CPT | 74183 | 5 | $4,290 | $3,218 | $3,003 | $3,861 | $4,505 |
| Abdominal ultrasound complete | CPT | 76700 | 5 | $367 | $275 | $257 | $330 | $385 |
| Abdominal ultrasound limited | CPT | 76705 | 5 | $333 | $250 | $233 | $300 | $350 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 5 | $354 | $266 | $248 | $319 | $372 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 5 | $414 | $311 | $290 | $373 | $435 |
| Transvaginal ultrasound | CPT | 76830 | 5 | $333 | $250 | $233 | $300 | $350 |
| Pelvic ultrasound complete | CPT | 76856 | 5 | $333 | $250 | $233 | $300 | $350 |
| Scrotal ultrasound | CPT | 76870 | 5 | $334 | $251 | $234 | $301 | $351 |
| EKG tracing only | CPT | 93005 | 5 | $170 | $128 | $119 | $153 | $178 |
| Transthoracic echocardiogram complete | CPT | 93306 | 5 | $1,480 | $1,110 | $1,036 | $1,332 | $1,554 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $99 | $74 | $69 | $89 | $104 |
| General health panel | CPT | 80050 | 5 | $263 | $197 | $184 | $237 | $276 |
| Electrolyte panel | CPT | 80051 | 5 | $30 | $23 | $21 | $27 | $32 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $173 | $130 | $121 | $156 | $182 |
| Lipid panel | CPT | 80061 | 5 | $92 | $69 | $64 | $83 | $97 |
| Renal function panel | CPT | 80069 | 5 | $240 | $180 | $168 | $216 | $252 |
| Hepatic function panel | CPT | 80076 | 5 | $108 | $81 | $76 | $97 | $113 |
| Urinalysis non-automated | CPT | 81002 | 5 | $45 | $34 | $31 | $41 | $47 |
| Urinalysis automated | CPT | 81003 | 5 | $30 | $23 | $21 | $27 | $32 |
| Glucose quantitative | CPT | 82947 | 5 | $55 | $41 | $18 | $32.5 | $58 |
| Hemoglobin A1c | CPT | 83036 | 5 | $64 | $48 | $45 | $58 | $67 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $116 | $87 | $81 | $104 | $122 |
| Complete blood count with automated differential | CPT | 85025 | 5 | $53 | $40 | $37 | $48 | $56 |
| Complete blood count without differential | CPT | 85027 | 5 | $44 | $33 | $31 | $40 | $46 |
| Urine culture identification | CPT | 87088 | 5 | $36 | $27 | $23 | $30.5 | $38 |
| maternity |
| Vaginal delivery only | CPT | 59409 | 5 | $8,038 | $6,029 | $5,627 | $7,234 | $8,440 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 5 | $105 | $79 | $74 | $95 | $110 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 5 | $145 | $109 | $102 | $131 | $152 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $200 | $150 | $140 | $180 | $210 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 5 | $240 | $180 | $168 | $216 | $252 |
| Office visit, established patient, 5 min | CPT | 99211 | 5 | $153 | $115 | $28 | $74.5 | $161 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 5 | $156 | $117 | $53 | $94 | $164 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 5 | $183 | $137 | $70 | $116.5 | $192 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 5 | $137 | $103 | $96 | $123 | $144 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 5 | $150 | $113 | $105 | $135 | $158 |