| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $627.57 | $313.79 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $1,151.64 | $575.82 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,006.91 | $1,003.46 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $3,243.33 | $1,621.67 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $4,727.7 | $2,363.85 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $6,660.18 | $3,330.09 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $5,224.29 | $2,612.15 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,516.44 | $758.22 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $4,352.06 | $2,176.03 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $4,860.38 | $2,430.19 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $7,300.62 | $3,650.31 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $382.87 | $191.44 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $783.48 | $391.74 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $938.02 | $469.01 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,100.38 | $1,550.19 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $3,771.35 | $1,885.68 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $4,306.23 | $2,153.12 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $830.3 | $415.15 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $3,735.35 | $1,867.68 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $7,302.75 | $3,651.38 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $7,473.53 | $3,736.77 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,738.22 | $1,369.11 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,738.22 | $1,369.11 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $5,452.63 | $2,726.32 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $3,737.81 | $1,868.91 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $904.14 | $452.07 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $744.99 | $372.5 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $841.23 | $420.62 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $7,429.5 | $3,714.75 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $835.78 | $417.89 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $720.55 | $360.28 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,738.22 | $1,369.11 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,716.9 | $858.45 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $4,691.17 | $2,345.59 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $3,032.88 | $1,516.44 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $8,937.11 | $4,468.56 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $8,025.26 | $4,012.63 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $7,998.11 | $3,999.06 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,393.86 | $696.93 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,738.22 | $1,369.11 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $2,081.77 | $1,040.89 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $1,543.5 | $771.75 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,316.81 | $658.41 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $2,244.41 | $1,122.21 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $2,030.8 | $1,015.4 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,323.27 | $661.64 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,515.41 | $757.71 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $1,613.9 | $806.95 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $536.25 | $268.13 | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $324.48 | $162.24 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $584.41 | $292.21 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $197.16 | $98.58 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $9,389 | $4,694.5 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $2,920.14 | $1,460.07 | — | — | — | — |
| inpatient |
| COPD w/o CC/MCC | MS-DRG | 192 | 0 | $33,293 | $16,646 | — | — | — | — |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $410 | $205 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $610 | $305 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $602 | $301 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $882.88 | $441.44 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $614.5 | $307.25 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $1,006 | $503 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $525.48 | $262.74 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $761.26 | $380.63 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $425.87 | $212.94 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $1,039.35 | $519.68 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $372.36 | $186.18 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $83.85 | $41.93 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $168.36 | $84.18 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $313.98 | $156.99 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $84.36 | $42.18 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $403.9 | $201.95 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $468.4 | $234.2 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $194.4 | $97.2 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $300.39 | $150.2 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $52.38 | $26.19 | — | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $13,637 | $6,818.31 | — | — | — | — |
| surgery |
| Umbilical hernia repair age 5+ | CPT | 49585 | 0 | $2,625.36 | $1,312.68 | — | — | — | — |