| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $1,500 | $1,470 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $518.25 | $507.89 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $293.8 | $287.92 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $1,180 | $1,156.4 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $528.84 | $518.26 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $528.84 | $518.26 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $227.12 | $222.58 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $227.12 | $222.58 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $454.24 | $445.16 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $908.48 | $890.31 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $1,589.84 | $1,558.04 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $99.96 | $97.96 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $142.8 | $139.94 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $171.36 | $167.93 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $223.72 | $219.25 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $776.16 | $760.64 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,146.6 | $1,123.67 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $1,305.36 | $1,279.25 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $93.45 | $91.58 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $155.75 | $152.64 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $218.05 | $213.69 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $171.36 | $167.93 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $223.72 | $219.25 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $276.08 | $270.56 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,693.44 | $1,659.57 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $1,852.2 | $1,815.16 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,310.84 | $2,264.62 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $218.05 | $213.69 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $176.12 | $172.6 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $171.36 | $167.93 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $171.36 | $167.93 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $740.88 | $726.06 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $740.88 | $726.06 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $740.88 | $726.06 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $1,146.6 | $1,123.67 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $1,305.36 | $1,279.25 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $1,305.36 | $1,279.25 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $123.76 | $121.28 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $223.72 | $219.25 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $155.75 | $152.64 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $186.9 | $183.16 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $186.9 | $183.16 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $829.08 | $812.5 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $1,799.28 | $1,763.29 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $186.9 | $183.16 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $186.9 | $183.16 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $829.08 | $812.5 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $1,799.28 | $1,763.29 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $119 | $116.62 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $223.72 | $219.25 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $257.04 | $251.9 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $152.32 | $149.27 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $295.12 | $289.22 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $337.96 | $331.2 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,287.72 | $1,261.97 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $1,958.04 | $1,918.88 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $716.45 | $702.12 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $560.7 | $549.49 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $685.3 | $671.59 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $654.15 | $641.07 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $809.9 | $793.7 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $747.6 | $732.65 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $778.75 | $763.18 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $654.15 | $641.07 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $311.5 | $305.27 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $809.9 | $793.7 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $1,059.1 | $1,037.92 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $872.2 | $854.76 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $74.52 | $73.03 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $372.6 | $365.15 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $279.45 | $273.86 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $372.6 | $365.15 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $34.43 | $33.74 | — | — | — |
| General health panel | CPT | 80050 | 0 | $150.24 | $147.24 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $25.04 | $24.54 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $46.95 | $46.01 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $59.47 | $58.28 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $37.56 | $36.81 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $34.43 | $33.74 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $12.52 | $12.27 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $12.52 | $12.27 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $12.52 | $12.27 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $62.6 | $61.35 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $46.95 | $46.01 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $31.3 | $30.67 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $25.04 | $24.54 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $62.6 | $61.35 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $31.3 | $30.67 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $187.8 | $184.04 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $621.6 | $609.17 | — | — | — |
| Vaginal delivery only | CPT | 59409 | 0 | $3,978.24 | $3,898.68 | — | — | — |
| C-section delivery only | CPT | 59514 | 0 | $7,583.52 | $7,431.85 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $176.28 | $172.75 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $235.04 | $230.34 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $293.8 | $287.92 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $352.56 | $345.51 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $124.32 | $121.83 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $176.28 | $172.75 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $235.04 | $230.34 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $293.8 | $287.92 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $352.56 | $345.51 | — | — | — |
| surgery |
| Left heart catheterization | CPT | 93452 | 0 | $66.91 | $65.57 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $66.91 | $65.57 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $66.91 | $65.57 | — | — | — |