| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $759 | $743.82 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $316.25 | $309.93 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $379.5 | $371.91 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $569.25 | $557.87 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $569.25 | $557.87 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $185.87 | $182.15 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $185.87 | $182.15 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $371.74 | $364.31 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $743.48 | $728.61 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,301.09 | $1,275.07 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $76.44 | $74.91 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $109.2 | $107.02 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $131.04 | $128.42 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $171.08 | $167.66 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $592.24 | $580.4 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $874.9 | $857.4 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $996.04 | $976.12 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $93 | $91.14 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $155 | $151.9 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $217 | $212.66 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $131.04 | $128.42 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $171.08 | $167.66 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $211.12 | $206.9 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,292.16 | $1,266.32 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,413.3 | $1,385.03 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,763.26 | $1,727.99 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $217 | $212.66 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $134.68 | $131.99 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $131.04 | $128.42 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $131.04 | $128.42 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $565.32 | $554.01 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $565.32 | $554.01 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $565.32 | $554.01 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $874.9 | $857.4 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $996.04 | $976.12 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $996.04 | $976.12 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $94.64 | $92.75 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $171.08 | $167.66 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $155 | $151.9 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $186 | $182.28 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $186 | $182.28 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $632.62 | $619.97 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,372.92 | $1,345.46 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $186 | $182.28 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $186 | $182.28 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $632.62 | $619.97 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,372.92 | $1,345.46 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $91 | $89.18 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $171.08 | $167.66 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $196.56 | $192.63 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $116.48 | $114.15 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $225.68 | $221.17 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $258.44 | $253.27 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $982.58 | $962.93 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,494.06 | $1,464.18 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $713 | $698.74 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $558 | $546.84 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $682 | $668.36 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $651 | $637.98 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $806 | $789.88 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $744 | $729.12 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $775 | $759.5 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $651 | $637.98 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $310 | $303.8 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $94.08 | $92.2 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $470.4 | $460.99 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $352.8 | $345.74 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $470.4 | $460.99 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $30.03 | $29.43 | — | — | — |
| General health panel | CPT | 80050 | 0 | $109.2 | $107.02 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $21.84 | $21.4 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $40.95 | $40.13 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $51.87 | $50.83 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $32.76 | $32.1 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $30.03 | $29.43 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $10.92 | $10.7 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $10.92 | $10.7 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $54.6 | $53.51 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $40.95 | $40.13 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $27.3 | $26.75 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $21.84 | $21.4 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $54.6 | $53.51 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $27.3 | $26.75 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $163.8 | $160.52 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $885.2 | $867.5 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $5,665.28 | $5,551.97 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $10,799 | $10,583 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $189.75 | $185.96 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $253 | $247.94 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $316.25 | $309.93 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $379.5 | $371.91 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $177.04 | $173.5 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $189.75 | $185.96 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $253 | $247.94 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $316.25 | $309.93 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $379.5 | $371.91 | — | — | — |
| surgery |
| Left heart catheterization | CPT | 93452 | 0 | $140.22 | $137.42 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $140.22 | $137.42 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $140.22 | $137.42 | — | — | — |