| behavioral |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $610 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $755 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $770 | — | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $295 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $390 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $806 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $1,273 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,921 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,542 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $2,140 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $2,458 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $2,910 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $4,046 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $291 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $370 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,752 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,752 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,031 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $2,910 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $532 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,407 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,407 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $2,407 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,209 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,209 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $2,910 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,238 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $4,232 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $2,272 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,272 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $358 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $309 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $313 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $2,910 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,578 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $295 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $309 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $2,910 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,578 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $2,458 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,458 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,524 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $4,278 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $4,278 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,946 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $4,211 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $4,613 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,095 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $736 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $917 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $904 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,024 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,024 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $703 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $804 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $761 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $437 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $536 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $467 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $287 | — | — | — | — |
| EKG interpretation only | CPT | 93010 | 0 | $227 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,040 | — | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $434 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $580 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $704 | — | — | — | — |
| Hospital discharge, <30 min | CPT | 99238 | 0 | $329 | — | — | — | — |
| Hospital discharge, >30 min | CPT | 99239 | 0 | $477 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $352 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $284 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $469 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $312 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $403 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $313 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $88 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $73 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $179 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $181 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $142 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $128 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $207 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $384 | — | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $761 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $530 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $346 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $481 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $577 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $418 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $494 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $519 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $613 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $1,178 | — | — | — | — |
| surgery |
| Lap salpingo-oophorectomy | CPT | 58661 | 0 | $2,901 | — | — | — | — |