| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $875.52 | $858.01 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $1,094.4 | $1,072.51 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $364.8 | $357.5 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $437.76 | $429 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $656.64 | $643.51 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $656.64 | $643.51 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $196.06 | $192.14 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $196.06 | $192.14 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $392.12 | $384.28 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $784.24 | $768.56 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,372.42 | $1,344.97 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $225.12 | $220.62 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $321.6 | $315.17 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $385.92 | $378.2 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $503.84 | $493.76 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $753.28 | $738.21 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,112.8 | $1,090.54 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,266.88 | $1,241.54 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $148.08 | $145.12 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $246.8 | $241.86 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $345.52 | $338.61 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $385.92 | $378.2 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $503.84 | $493.76 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $621.76 | $609.32 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,643.52 | $1,610.65 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,242.72 | $2,197.87 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $345.52 | $338.61 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $396.64 | $388.71 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $385.92 | $378.2 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $385.92 | $378.2 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $719.04 | $704.66 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $719.04 | $704.66 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $719.04 | $704.66 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,112.8 | $1,090.54 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,266.88 | $1,241.54 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,266.88 | $1,241.54 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $278.72 | $273.15 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $503.84 | $493.76 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $246.8 | $241.86 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $296.16 | $290.24 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $296.16 | $290.24 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $804.64 | $788.55 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,746.24 | $1,711.32 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $296.16 | $290.24 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $296.16 | $290.24 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $804.64 | $788.55 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,746.24 | $1,711.32 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $268 | $262.64 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $503.84 | $493.76 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $578.88 | $567.3 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $343.04 | $336.18 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $664.64 | $651.35 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $761.12 | $745.9 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,249.76 | $1,224.76 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,900.32 | $1,862.31 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $1,135.28 | $1,112.57 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $888.48 | $870.71 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $1,085.92 | $1,064.2 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $1,036.56 | $1,015.83 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $1,283.36 | $1,257.69 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,184.64 | $1,160.95 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $1,234 | $1,209.32 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $1,036.56 | $1,015.83 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $493.6 | $483.73 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $1,283.36 | $1,257.69 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,678.24 | $1,644.68 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $1,382.08 | $1,354.44 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $105.72 | $103.61 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $528.6 | $518.03 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $396.45 | $388.52 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $528.6 | $518.03 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $33.22 | $32.56 | — | — | — |
| General health panel | CPT | 80050 | 0 | $120.8 | $118.38 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $24.16 | $23.68 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $45.3 | $44.39 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $57.38 | $56.23 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $36.24 | $35.52 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $33.22 | $32.56 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $12.08 | $11.84 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $12.08 | $11.84 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $12.08 | $11.84 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $60.4 | $59.19 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $45.3 | $44.39 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $30.2 | $29.6 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $24.16 | $23.68 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $60.4 | $59.19 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $30.2 | $29.6 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $181.2 | $177.58 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $218.88 | $214.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $291.84 | $286 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $364.8 | $357.5 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $437.76 | $429 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $145.92 | $143 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $218.88 | $214.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $291.84 | $286 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $364.8 | $357.5 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $437.76 | $429 | — | — | — |
| surgery |
| Intravitreal injection | CPT | 67028 | 0 | $312.6 | $306.35 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $96.69 | $94.76 | — | — | — |