| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $127.49 | $124.94 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $127.49 | $124.94 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $254.98 | $249.88 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $509.96 | $499.76 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $892.43 | $874.58 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $63 | $61.74 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $90 | $88.2 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $108 | $105.84 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $141 | $138.18 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $282.04 | $276.4 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $416.65 | $408.32 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $474.34 | $464.85 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $80.13 | $78.53 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $133.55 | $130.88 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $186.97 | $183.23 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $108 | $105.84 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $141 | $138.18 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $174 | $170.52 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $615.36 | $603.05 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $839.71 | $822.92 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $186.97 | $183.23 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $111 | $108.78 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $108 | $105.84 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $108 | $105.84 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $269.22 | $263.84 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $269.22 | $263.84 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $269.22 | $263.84 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $416.65 | $408.32 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $474.34 | $464.85 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $474.34 | $464.85 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $78 | $76.44 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $141 | $138.18 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $133.55 | $130.88 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $160.26 | $157.05 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $160.26 | $157.05 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $301.27 | $295.24 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $653.82 | $640.74 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $160.26 | $157.05 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $160.26 | $157.05 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $301.27 | $295.24 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $653.82 | $640.74 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $75 | $73.5 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $141 | $138.18 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $162 | $158.76 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $96 | $94.08 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $186 | $182.28 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $213 | $208.74 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $467.93 | $458.57 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $711.51 | $697.28 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $614.33 | $602.04 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $480.78 | $471.16 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $587.62 | $575.87 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $560.91 | $549.69 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $694.46 | $680.57 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $667.75 | $654.4 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $560.91 | $549.69 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $267.1 | $261.76 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $694.46 | $680.57 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $908.14 | $889.98 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $747.88 | $732.92 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $58.8 | $57.62 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $294 | $288.12 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $220.5 | $216.09 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $32.12 | $31.48 | — | — | — |
| General health panel | CPT | 80050 | 0 | $116.8 | $114.46 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $23.36 | $22.89 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $43.8 | $42.92 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $55.48 | $54.37 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $35.04 | $34.34 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $32.12 | $31.48 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $11.68 | $11.45 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $11.68 | $11.45 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $11.68 | $11.45 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $58.4 | $57.23 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $43.8 | $42.92 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $29.2 | $28.62 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $23.36 | $22.89 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $58.4 | $57.23 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $29.2 | $28.62 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $175.2 | $171.7 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $1,185.7 | $1,161.99 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $7,588.48 | $7,436.71 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $14,466 | $14,176 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $140.31 | $137.5 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $187.08 | $183.34 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $233.85 | $229.17 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $280.62 | $275.01 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $237.14 | $232.4 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $140.31 | $137.5 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $187.08 | $183.34 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $233.85 | $229.17 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $280.62 | $275.01 | — | — | — |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 0 | $94.41 | $92.52 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $94.41 | $92.52 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $94.41 | $92.52 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $94.41 | $92.52 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $94.41 | $92.52 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $94.41 | $92.52 | — | — | — |