| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $257.5 | $234.33 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $378.9 | $344.8 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $529.4 | $481.75 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $886.1 | $806.35 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,454.5 | $1,323.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $2,225.4 | $2,025.11 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,870.7 | $1,702.34 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,242.2 | $2,040.4 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,740.1 | $2,493.49 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,449.8 | $2,229.32 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,373.5 | $2,159.89 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,734.1 | $2,488.03 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $3,479.3 | $3,166.16 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $226 | $205.66 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $288.6 | $262.63 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $334.4 | $304.3 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $3,941.5 | $3,586.77 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $4,899.2 | $4,458.27 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $8,632.9 | $7,855.94 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,357.9 | $2,145.69 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,711.9 | $2,467.83 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $3,466.7 | $3,154.7 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $303.2 | $275.91 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,120.4 | $1,929.56 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,120.4 | $1,929.56 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,120.4 | $1,929.56 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $2,450.8 | $2,230.23 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $2,454.9 | $2,233.96 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,467 | $2,244.97 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,768.7 | $2,519.52 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $3,539.9 | $3,221.31 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $3,544.9 | $3,225.86 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,870.7 | $1,702.34 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,242.6 | $2,040.77 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $257.5 | $234.33 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $253.6 | $230.78 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $239.8 | $218.22 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,308.9 | $2,101.1 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,270.3 | $2,975.97 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $508.2 | $462.46 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $239.8 | $218.22 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,304.7 | $2,097.28 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,236.5 | $2,945.22 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,870.7 | $1,702.34 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,449.8 | $2,229.32 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,896.4 | $2,635.72 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $5,431.5 | $4,942.67 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $7,141.8 | $6,499.04 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $5,714.5 | $5,200.2 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $2,375.7 | $2,161.89 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $3,336.8 | $3,036.49 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $968 | $880.88 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $700.3 | $637.27 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $938 | $853.58 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $757 | $688.87 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,090 | $991.9 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $479.7 | $436.53 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $479.7 | $436.53 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $754.3 | $686.41 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $335.7 | $305.49 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $402.5 | $366.28 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $607.6 | $552.92 | — | — | — |
| EKG complete | CPT | 93000 | 0 | $186 | $169.26 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $255.7 | $232.69 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,926.6 | $2,663.21 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $48.5 | $44.14 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $125.5 | $114.21 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $62.5 | $56.88 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $163.2 | $148.51 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $159.8 | $145.42 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $155.2 | $141.23 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $38.5 | $35.04 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $40.2 | $36.58 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $70 | $63.7 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $107.9 | $98.19 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $184 | $167.44 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $138.8 | $126.31 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $118.7 | $108.02 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $46.4 | $42.22 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $84.7 | $77.08 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $106 | $96.46 | — | — | — |
| maternity |
| Vaginal delivery only | CPT | 59409 | 0 | $2,435.3 | $2,216.12 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $166.9 | $151.88 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $240.7 | $219.04 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $345 | $313.95 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $425.4 | $387.11 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $144.9 | $131.86 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $101.3 | $92.18 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $178.3 | $162.25 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $212.1 | $193.01 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $299 | $272.09 | — | — | — |
| preventive |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $622 | $566.02 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $479.6 | $436.44 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,638.2 | $1,490.76 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $1,840.3 | $1,674.67 | — | — | — |
