| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $125.92 | $123.4 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $125.92 | $123.4 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $251.84 | $246.8 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $503.68 | $493.61 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $881.43 | $863.8 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $881.43 | $863.8 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $87.21 | $85.47 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $124.59 | $122.1 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $149.51 | $146.52 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $195.19 | $191.29 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $874.09 | $856.61 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,291.27 | $1,265.44 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,470.06 | $1,440.66 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $109.4 | $107.21 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $182.34 | $178.69 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $255.28 | $250.17 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $149.51 | $146.52 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $195.19 | $191.29 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $240.88 | $236.06 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,907.11 | $1,868.97 | — | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,085.9 | $2,044.18 | — | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,602.41 | $2,550.36 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $255.28 | $250.17 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $153.66 | $150.59 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $149.51 | $146.52 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $149.51 | $146.52 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $834.36 | $817.67 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $834.36 | $817.67 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $834.36 | $817.67 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,291.27 | $1,265.44 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,470.06 | $1,440.66 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,470.06 | $1,440.66 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $107.98 | $105.82 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $195.19 | $191.29 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $182.34 | $178.69 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $218.81 | $214.43 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $218.81 | $214.43 | — | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $933.69 | $915.02 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,026.31 | $1,985.78 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $218.81 | $214.43 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $218.81 | $214.43 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $933.69 | $915.02 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $2,026.31 | $1,985.78 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $103.83 | $101.75 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $195.19 | $191.29 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $224.26 | $219.77 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $132.9 | $130.24 | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $257.49 | $252.34 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $294.87 | $288.97 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,450.2 | $1,421.2 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,205.1 | $2,161 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $838.76 | $821.98 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $656.42 | $643.29 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $802.29 | $786.24 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $765.83 | $750.51 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $948.17 | $929.21 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $875.23 | $857.73 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $911.7 | $893.47 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $765.83 | $750.51 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $364.68 | $357.39 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $78.32 | $76.75 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $398.12 | $390.16 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $24.49 | $24 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $17.81 | $17.45 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $33.4 | $32.73 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $42.3 | $41.45 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $26.72 | $26.19 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $24.49 | $24 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $8.91 | $8.73 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $8.91 | $8.73 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $8.91 | $8.73 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $44.53 | $43.64 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $33.4 | $32.73 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $22.26 | $21.81 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $17.81 | $17.45 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $44.53 | $43.64 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $22.26 | $21.81 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $133.59 | $130.92 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $284.86 | $279.16 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $379.81 | $372.21 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $474.77 | $465.27 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $569.72 | $558.33 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $189.91 | $186.11 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $284.86 | $279.16 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $379.81 | $372.21 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $474.77 | $465.27 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $569.72 | $558.33 | — | — | — | — |