| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $125.45 | $122.94 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $125.45 | $122.94 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $250.9 | $245.88 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $501.8 | $491.76 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $878.15 | $860.59 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $79.8 | $78.2 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $114 | $111.72 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $136.8 | $134.06 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $178.6 | $175.03 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $462.44 | $453.19 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $683.15 | $669.49 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $777.74 | $762.19 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $119.31 | $116.92 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $198.85 | $194.87 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $278.39 | $272.82 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $136.8 | $134.06 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $178.6 | $175.03 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $220.4 | $215.99 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,008.96 | $988.78 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $1,376.81 | $1,349.27 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $278.39 | $272.82 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $140.6 | $137.79 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $136.8 | $134.06 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $136.8 | $134.06 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $441.42 | $432.59 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $441.42 | $432.59 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $441.42 | $432.59 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $683.15 | $669.49 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $777.74 | $762.19 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $777.74 | $762.19 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $98.8 | $96.82 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $178.6 | $175.03 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $198.85 | $194.87 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $238.62 | $233.85 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $238.62 | $233.85 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $493.97 | $484.09 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,072.02 | $1,050.58 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $238.62 | $233.85 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $238.62 | $233.85 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $493.97 | $484.09 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,072.02 | $1,050.58 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $95 | $93.1 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $178.6 | $175.03 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $205.2 | $201.1 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $121.6 | $119.17 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $235.6 | $230.89 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $269.8 | $264.4 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $767.23 | $751.89 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,166.61 | $1,143.28 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $914.71 | $896.42 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $715.86 | $701.54 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $874.94 | $857.44 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $835.17 | $818.47 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,034.02 | $1,013.34 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $994.25 | $974.37 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $835.17 | $818.47 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $397.7 | $389.75 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,034.02 | $1,013.34 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,352.18 | $1,325.14 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,113.56 | $1,091.29 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $30.84 | $30.22 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $154.2 | $151.12 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $115.65 | $113.34 | — | — | — |
| 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 | $991.4 | $971.57 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $6,344.96 | $6,218.06 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $12,095 | $11,853 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $123.39 | $120.92 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $164.52 | $161.23 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $205.65 | $201.54 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $246.78 | $241.84 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $198.28 | $194.31 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $123.39 | $120.92 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $164.52 | $161.23 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $205.65 | $201.54 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $246.78 | $241.84 | — | — | — |