| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $157.5 | $154.35 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $157.5 | $154.35 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $315 | $308.7 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $630 | $617.4 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,102.5 | $1,080.45 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $263.34 | $258.07 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $376.2 | $368.68 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $451.44 | $442.41 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $589.38 | $577.59 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $566.28 | $554.95 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $836.55 | $819.82 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $952.38 | $933.33 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $117.87 | $115.51 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $196.45 | $192.52 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $275.03 | $269.53 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $451.44 | $442.41 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $589.38 | $577.59 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $727.32 | $712.77 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,235.52 | $1,210.81 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,351.35 | $1,324.32 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,685.97 | $1,652.25 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $275.03 | $269.53 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $463.98 | $454.7 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $451.44 | $442.41 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $451.44 | $442.41 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $540.54 | $529.73 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $540.54 | $529.73 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $540.54 | $529.73 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $836.55 | $819.82 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $952.38 | $933.33 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $952.38 | $933.33 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $326.04 | $319.52 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $589.38 | $577.59 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $196.45 | $192.52 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $235.74 | $231.03 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $235.74 | $231.03 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $604.89 | $592.79 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,312.74 | $1,286.49 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $235.74 | $231.03 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $235.74 | $231.03 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $604.89 | $592.79 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,312.74 | $1,286.49 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $313.5 | $307.23 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $589.38 | $577.59 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $677.16 | $663.62 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $401.28 | $393.25 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $777.48 | $761.93 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $890.34 | $872.53 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $939.51 | $920.72 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,428.57 | $1,400 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $903.67 | $885.6 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $707.22 | $693.08 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $864.38 | $847.09 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $825.09 | $808.59 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,021.54 | $1,001.11 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $942.96 | $924.1 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $982.25 | $962.61 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $825.09 | $808.59 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $392.9 | $385.04 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,021.54 | $1,001.11 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,335.86 | $1,309.14 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,100.12 | $1,078.12 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $235.68 | $230.97 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,178.4 | $1,154.83 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $883.8 | $866.12 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $1,178.4 | $1,154.83 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $90.2 | $88.4 | — | — | — |
| General health panel | CPT | 80050 | 0 | $328 | $321.44 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $65.6 | $64.29 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $123 | $120.54 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $155.8 | $152.68 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $98.4 | $96.43 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $90.2 | $88.4 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $32.8 | $32.14 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $32.8 | $32.14 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $164 | $160.72 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $123 | $120.54 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $82 | $80.36 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $65.6 | $64.29 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $164 | $160.72 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $82 | $80.36 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $492 | $482.16 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $131.85 | $129.21 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $175.8 | $172.28 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $219.75 | $215.36 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $263.7 | $258.43 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $87.9 | $86.14 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $131.85 | $129.21 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $175.8 | $172.28 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $219.75 | $215.36 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $263.7 | $258.43 | — | — | — |