| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $773.72 | $758.25 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $967.24 | $947.9 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $322.42 | $315.97 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $386.88 | $379.14 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $580.29 | $568.68 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $580.29 | $568.68 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $158.5 | $155.33 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $158.5 | $155.33 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $317.01 | $310.67 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $634.02 | $621.34 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,109.53 | $1,087.34 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $111.4 | $109.17 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $159.15 | $155.97 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $190.98 | $187.16 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $249.33 | $244.34 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $732.57 | $717.92 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,082.2 | $1,060.56 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,232.05 | $1,207.41 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $111.46 | $109.23 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $185.77 | $182.05 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $260.07 | $254.87 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $190.98 | $187.16 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $249.33 | $244.34 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $307.68 | $301.53 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,598.33 | $1,566.36 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,748.18 | $1,713.22 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,181.06 | $2,137.44 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $260.07 | $254.87 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $196.28 | $192.35 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $190.98 | $187.16 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $190.98 | $187.16 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $699.27 | $685.28 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $699.27 | $685.28 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $699.27 | $685.28 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,082.2 | $1,060.56 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,232.05 | $1,207.41 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,232.05 | $1,207.41 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $137.93 | $135.17 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $249.33 | $244.34 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $371.53 | $364.1 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $222.92 | $218.46 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $445.84 | $436.92 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,565.03 | $1,533.73 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,396.46 | $3,328.53 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $445.84 | $436.92 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $445.84 | $436.92 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,565.03 | $1,533.73 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,396.46 | $3,328.53 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $132.62 | $129.97 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $249.33 | $244.34 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $286.46 | $280.73 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $169.76 | $166.36 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $328.9 | $322.32 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $376.65 | $369.12 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,215.4 | $1,191.09 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,848.07 | $1,811.11 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $854.53 | $837.44 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $668.76 | $655.38 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $817.37 | $801.02 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $780.22 | $764.62 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $965.99 | $946.67 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $891.68 | $873.85 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $928.83 | $910.25 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $780.22 | $764.62 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $371.53 | $364.1 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $965.99 | $946.67 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,263.21 | $1,237.95 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,040.29 | $1,019.48 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $56.78 | $55.64 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $283.92 | $278.24 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $212.94 | $208.68 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $283.92 | $278.24 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $32.96 | $32.3 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $23.97 | $23.49 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $44.95 | $44.05 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $56.94 | $55.8 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $35.96 | $35.24 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $32.96 | $32.3 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $11.99 | $11.75 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $11.99 | $11.75 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $59.93 | $58.73 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $44.95 | $44.05 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $29.97 | $29.37 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $23.97 | $23.49 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $59.93 | $58.73 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $29.97 | $29.37 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $179.8 | $176.2 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $193.4 | $189.53 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $257.94 | $252.78 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $322.44 | $315.99 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $386.88 | $379.14 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $129 | $126.42 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $193.4 | $189.53 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $257.94 | $252.78 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $322.44 | $315.99 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $386.88 | $379.14 | — | — | — |
