| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $450 | $337.5 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 1 | $295 | $221.25 | $100 | $101 | 0.68× | $102 |
| Psychotherapy 45 minutes | CPT | 90834 | 1 | $345 | $258.75 | $100 | $101 | 0.63× | $102 |
| Psychotherapy 60 minutes | CPT | 90837 | 1 | $395 | $296.25 | $100 | $101 | 0.53× | $102 |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,239 | $929.25 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $2,100 | $1,575 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,219 | $1,664.25 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $929 | $696.75 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $219 | $164.25 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $296 | $222 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $350 | $262.5 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,117 | $837.75 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,271 | $953.25 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $1,563 | $1,172.25 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $359 | $269.25 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,201 | $900.75 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,021 | $765.75 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,501 | $1,125.75 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,169 | $1,626.75 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $832 | $624 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $912 | $684 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $301 | $225.75 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,439 | $1,079.25 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,539 | $1,154.25 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,500 | $1,875 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $801 | $600.75 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $1,364 | $1,023 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $2,096 | $1,572 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,401 | $1,050.75 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,101 | $1,575.75 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $801 | $600.75 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $409 | $306.75 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $394.75 | $296.06 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $582 | $436.5 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $265 | $198.75 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $603 | $452.25 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $257 | $192.75 | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $520 | $390 | — | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $520 | $390 | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $110 | $82.5 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $181 | $135.75 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,001 | $750.75 | — | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $960 | $720 | — | — | — | — |
| inpatient |
| Initial hospital care, low complexity | CPT | 99221 | 0 | $298 | $223.5 | — | — | — | — |
| Initial hospital care, moderate complexity | CPT | 99222 | 0 | $398 | $298.5 | — | — | — | — |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $583 | $437.25 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $185.25 | $138.94 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $170 | $127.5 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $248 | $186 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $438.4 | $328.8 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $190 | $142.5 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $222.2 | $166.65 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $68 | $51 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $45 | $33.75 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $74 | $55.5 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $102 | $76.5 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $96 | $72 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $122 | $91.5 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $97 | $72.75 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $60 | $45 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $243 | $182.25 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $145 | $108.75 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $250 | $187.5 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $400 | $300 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $545 | $408.75 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $165 | $123.75 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $108 | $81 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $198 | $148.5 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $290 | $217.5 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $430 | $322.5 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 1 | $2,290 | $1,717.5 | $150 | $151.5 | 0.17× | $153 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,100 | $825 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $512 | $384 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,340 | $1,005 | — | — | — | — |