| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $965.64 | $946.33 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $1,207.05 | $1,182.91 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $402.35 | $394.3 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $482.82 | $473.16 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $724.23 | $709.75 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $160.94 | $157.72 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $141.62 | $138.79 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $141.62 | $138.79 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $283.24 | $277.58 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $566.48 | $555.15 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $991.34 | $971.51 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $244.23 | $239.35 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $348.9 | $341.92 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $418.68 | $410.31 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $546.61 | $535.68 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $675.84 | $662.32 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $998.4 | $978.43 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,136.64 | $1,113.91 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $121.41 | $118.98 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $202.35 | $198.3 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $283.29 | $277.62 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $418.68 | $410.31 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $546.61 | $535.68 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $674.54 | $661.05 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,474.56 | $1,445.07 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,612.8 | $1,580.54 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,012.16 | $1,971.92 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $283.29 | $277.62 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $430.31 | $421.7 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $418.68 | $410.31 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $418.68 | $410.31 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $645.12 | $632.22 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $645.12 | $632.22 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $645.12 | $632.22 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $998.4 | $978.43 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,136.64 | $1,113.91 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,136.64 | $1,113.91 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $302.38 | $296.33 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $546.61 | $535.68 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $202.35 | $198.3 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $242.82 | $237.96 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $242.82 | $237.96 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $721.92 | $707.48 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,566.72 | $1,535.39 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $242.82 | $237.96 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $242.82 | $237.96 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $721.92 | $707.48 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,566.72 | $1,535.39 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $290.75 | $284.94 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $546.61 | $535.68 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $628.02 | $615.46 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $372.16 | $364.72 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $721.06 | $706.64 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $825.73 | $809.22 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,121.28 | $1,098.85 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,704.96 | $1,670.86 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $930.81 | $912.19 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $728.46 | $713.89 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $890.34 | $872.53 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $849.87 | $832.87 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,052.22 | $1,031.18 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $971.28 | $951.85 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,011.75 | $991.52 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $849.87 | $832.87 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $404.7 | $396.61 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,052.22 | $1,031.18 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,375.98 | $1,348.46 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,133.16 | $1,110.5 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $136.8 | $134.06 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $684 | $670.32 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $513 | $502.74 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $684 | $670.32 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $37.18 | $36.44 | — | — | — |
| General health panel | CPT | 80050 | 0 | $135.2 | $132.5 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $27.04 | $26.5 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $50.7 | $49.69 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $64.22 | $62.94 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $40.56 | $39.75 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $37.18 | $36.44 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $13.52 | $13.25 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $13.52 | $13.25 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $67.6 | $66.25 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $50.7 | $49.69 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $33.8 | $33.12 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $27.04 | $26.5 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $67.6 | $66.25 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $33.8 | $33.12 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $202.8 | $198.74 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $904.7 | $886.61 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $5,790.08 | $5,674.28 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $11,037 | $10,817 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $241.41 | $236.58 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $321.88 | $315.44 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $402.35 | $394.3 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $482.82 | $473.16 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $180.94 | $177.32 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $241.41 | $236.58 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $321.88 | $315.44 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $402.35 | $394.3 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $482.82 | $473.16 | — | — | — |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 0 | $83.78 | $82.1 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $83.78 | $82.1 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $83.78 | $82.1 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $83.78 | $82.1 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $83.78 | $82.1 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $83.78 | $82.1 | — | — | — |