| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $751.89 | $736.85 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $939.86 | $921.06 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $313.32 | $307.05 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $375.94 | $368.42 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $563.93 | $552.65 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $563.93 | $552.65 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $139.43 | $136.64 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $139.43 | $136.64 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $278.87 | $273.29 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $557.74 | $546.59 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $976.04 | $956.52 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $139.26 | $136.47 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $198.95 | $194.97 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $238.74 | $233.97 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $311.68 | $305.45 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $713.85 | $699.57 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,054.55 | $1,033.46 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,200.57 | $1,176.56 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $148.41 | $145.44 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $247.35 | $242.4 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $346.3 | $339.37 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $238.74 | $233.97 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $311.68 | $305.45 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $384.63 | $376.94 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,557.5 | $1,526.35 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,703.51 | $1,669.44 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,125.33 | $2,082.82 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $346.3 | $339.37 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $245.37 | $240.46 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $238.74 | $233.97 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $238.74 | $233.97 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $681.4 | $667.77 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $681.4 | $667.77 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $681.4 | $667.77 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,054.55 | $1,033.46 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,200.57 | $1,176.56 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,200.57 | $1,176.56 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $172.42 | $168.97 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $311.68 | $305.45 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $494.71 | $484.82 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $296.83 | $290.89 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $593.65 | $581.78 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,525.05 | $1,494.55 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $3,309.68 | $3,243.49 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $593.65 | $581.78 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $593.65 | $581.78 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,525.05 | $1,494.55 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,309.68 | $3,243.49 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $165.79 | $162.47 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $311.68 | $305.45 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $358.1 | $350.94 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $212.21 | $207.97 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $411.16 | $402.94 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $470.84 | $461.42 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,184.35 | $1,160.66 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,800.86 | $1,764.84 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,137.83 | $1,115.07 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $890.48 | $872.67 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,088.36 | $1,066.59 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,038.89 | $1,018.11 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,286.25 | $1,260.53 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,187.3 | $1,163.55 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,236.77 | $1,212.03 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,038.89 | $1,018.11 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $494.71 | $484.82 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,286.25 | $1,260.53 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,682.01 | $1,648.37 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,385.19 | $1,357.49 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $73.15 | $71.69 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $365.77 | $358.45 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $274.33 | $268.84 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $365.77 | $358.45 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $36.5 | $35.77 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $26.54 | $26.01 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $49.77 | $48.77 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $63.04 | $61.78 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $39.82 | $39.02 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $36.5 | $35.77 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $13.27 | $13 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $13.27 | $13 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $66.36 | $65.03 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $49.77 | $48.77 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $33.18 | $32.52 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $26.54 | $26.01 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $66.36 | $65.03 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $33.18 | $32.52 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $199.09 | $195.11 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $187.95 | $184.19 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $250.62 | $245.61 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $313.26 | $306.99 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $375.94 | $368.42 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $125.3 | $122.79 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $187.95 | $184.19 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $250.62 | $245.61 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $313.26 | $306.99 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $375.94 | $368.42 | — | — | — |