| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $710 | $355 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $1,094 | $547 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $367 | $183.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $573 | $286.5 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $663 | $331.5 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $295 | $147.5 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $221 | $110.5 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $342 | $171 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $684 | $342 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $855 | $427.5 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $983 | $491.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,302 | $651 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,668 | $1,334 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,884 | $1,442 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $3,380 | $1,690 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,804 | $902 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $3,600 | $1,800 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,831 | $2,415.5 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $341 | $170.5 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $438 | $219 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $2,650 | $1,325 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $2,900 | $1,450 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $3,399 | $1,699.5 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $4,348 | $2,174 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $521 | $260.5 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,650 | $1,325 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,650 | $1,325 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,650 | $1,325 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $3,600 | $1,800 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $4,831 | $2,415.5 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,943 | $1,971.5 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,243 | $1,121.5 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,817 | $1,408.5 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $378 | $189 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $710 | $355 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $616 | $308 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,660 | $1,330 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $343 | $171.5 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $376 | $188 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,089 | $1,544.5 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,540 | $1,270 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,817 | $1,408.5 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,363 | $1,681.5 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,668 | $1,334 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,884 | $1,442 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,380 | $1,690 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,089 | $1,544.5 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,831 | $2,415.5 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $649 | $324.5 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $861 | $430.5 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $951 | $475.5 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $313 | $156.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $800 | $400 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $944 | $472 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $989 | $494.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $951 | $475.5 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $650 | $325 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $363 | $181.5 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $441 | $220.5 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $401 | $200.5 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $291 | $145.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $1,075 | $537.5 | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $27 | $13.5 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $3,704 | $1,852 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $286 | $143 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $139 | $69.5 | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $173 | $86.5 | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $378 | $189 | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $557 | $278.5 | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $202 | $101 | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $296 | $148 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $78 | $39 | — | — | — |
| General health panel | CPT | 80050 | 0 | $486 | $243 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65 | $32.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $98 | $49 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $125 | $62.5 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $80 | $40 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $76 | $38 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $30 | $15 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $57 | $28.5 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $55 | $27.5 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $153 | $76.5 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $153 | $76.5 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $85 | $42.5 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $68 | $34 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $143 | $71.5 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $784 | $392 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $387 | $193.5 | — | — | — |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 0 | $5,230 | $2,615 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $1,753 | $876.5 | — | — | — |
| Vaginal delivery with postpartum | CPT | 59410 | 0 | $2,359 | $1,179.5 | — | — | — |
| Routine obstetric care with C-section | CPT | 59510 | 0 | $5,893 | $2,946.5 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $2,014 | $1,007 | — | — | — |
| C-section with postpartum | CPT | 59515 | 0 | $2,978 | $1,489 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $103 | $51.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $180 | $90 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $292 | $146 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $396 | $198 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $50 | $25 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $86 | $43 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $144 | $72 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $211 | $105.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $332 | $166 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,585.33 | $792.67 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,132 | $1,066 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,530.66 | $765.33 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,570 | $785 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $3,280 | $1,640 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $4,239 | $2,119.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,772 | $1,886 | — | — | — |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 0 | $2,991 | $1,495.5 | — | — | — |
| Hip hemiarthroplasty | CPT | 27125 | 0 | $2,370 | $1,185 | — | — | — |
| Total hip replacement | CPT | 27130 | 0 | $2,677 | $1,338.5 | — | — | — |
| Total knee replacement | CPT | 27447 | 0 | $2,672 | $1,336 | — | — | — |
| Knee revision arthroplasty single component | CPT | 27486 | 0 | $2,930 | $1,465 | — | — | — |
| Knee revision arthroplasty all components | CPT | 27487 | 0 | $3,639 | $1,819.5 | — | — | — |
| Shoulder arthroscopy with decompression | CPT | 29826 | 0 | $348 | $174 | — | — | — |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 0 | $2,226 | $1,113 | — | — | — |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 0 | $1,156 | $578 | — | — | — |
| ACL reconstruction | CPT | 29888 | 0 | $2,027 | $1,013.5 | — | — | — |
| CABG single arterial graft | CPT | 33533 | 0 | $4,176 | $2,088 | — | — | — |
| Open appendectomy | CPT | 44950 | 0 | $19,838 | $9,919 | — | — | — |
| Laparoscopic appendectomy | CPT | 44970 | 0 | $16,287 | $8,143.5 | — | — | — |
| Laparoscopic cholecystectomy | CPT | 47562 | 0 | $14,823 | $7,411.5 | — | — | — |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 0 | $1,799.5 | $899.75 | — | — | — |
| Lap inguinal hernia repair | CPT | 49650 | 0 | $19,215 | $9,607.5 | — | — | — |
| Total abdominal hysterectomy | CPT | 58150 | 0 | $35,904 | $17,952 | — | — | — |
| Vaginal hysterectomy | CPT | 58260 | 0 | $1,718 | $859 | — | — | — |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 0 | $26,390 | $13,195 | — | — | — |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 0 | $26,936 | $13,468 | — | — | — |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $18,117 | $9,058.5 | — | — | — |
| Complex cataract surgery | CPT | 66982 | 0 | $9,282 | $4,641 | — | — | — |
| Cataract surgery with lens implant | CPT | 66984 | 0 | $7,280 | $3,640 | — | — | — |
| Intravitreal injection | CPT | 67028 | 0 | $1,686 | $843 | — | — | — |