| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $355.85 | $348.73 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $59.29 | $58.1 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $148.32 | $145.35 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $177.89 | $174.33 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $266.88 | $261.54 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $266.82 | $261.48 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $312.95 | $306.69 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $120.55 | $118.14 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $241.1 | $236.28 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $482.2 | $472.56 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $843.85 | $826.97 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $120.65 | $118.24 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $172.36 | $168.91 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $206.83 | $202.69 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $270.03 | $264.63 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $557.21 | $546.07 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $823.14 | $806.68 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $937.12 | $918.38 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $97.93 | $95.97 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $163.22 | $159.96 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $228.5 | $223.93 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $206.83 | $202.69 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $270.03 | $264.63 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $333.23 | $326.57 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,215.72 | $1,191.41 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,329.7 | $1,303.11 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,658.95 | $1,625.77 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $228.5 | $223.93 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $212.58 | $208.33 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $206.83 | $202.69 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $206.83 | $202.69 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $531.88 | $521.24 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $531.88 | $521.24 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $531.88 | $521.24 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $823.14 | $806.68 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $937.12 | $918.38 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $937.12 | $918.38 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $149.38 | $146.39 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $270.03 | $264.63 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $326.43 | $319.9 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $195.86 | $191.94 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $391.72 | $383.89 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,190.39 | $1,166.58 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,583.41 | $2,531.74 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $391.72 | $383.89 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $391.72 | $383.89 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,190.39 | $1,166.58 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,583.41 | $2,531.74 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $143.63 | $140.76 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $270.03 | $264.63 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $310.25 | $304.05 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $183.85 | $180.17 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $356.21 | $349.09 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $407.92 | $399.76 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $924.45 | $905.96 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,405.68 | $1,377.57 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $750.79 | $735.77 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $587.58 | $575.83 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $718.15 | $703.79 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $685.51 | $671.8 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $848.72 | $831.75 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $783.44 | $767.77 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $816.08 | $799.76 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $685.51 | $671.8 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $326.43 | $319.9 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $848.72 | $831.75 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,109.87 | $1,087.67 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $914.01 | $895.73 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $55.52 | $54.41 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $277.59 | $272.04 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $208.2 | $204.04 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $277.59 | $272.04 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $32.72 | $32.07 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $23.8 | $23.32 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $44.62 | $43.73 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $56.52 | $55.39 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $35.7 | $34.99 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $32.72 | $32.07 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $11.9 | $11.66 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $11.9 | $11.66 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $59.49 | $58.3 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $44.62 | $43.73 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $29.75 | $29.16 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $23.8 | $23.32 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $59.49 | $58.3 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $29.75 | $29.16 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $178.48 | $174.91 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,564.77 | $1,533.47 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $19,403 | $19,015 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $14,709 | $14,415 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $89.02 | $87.24 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $118.62 | $116.25 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $148.27 | $145.3 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $177.86 | $174.3 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $59.29 | $58.1 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $89.02 | $87.24 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $118.62 | $116.25 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $148.27 | $145.3 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $177.86 | $174.3 | — | — | — |