| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $289 | $173.4 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $289 | $173.4 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $161 | $96.6 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $275 | $165 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $300 | $180 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $300 | $180 | — | — | — |
| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $307 | $184.2 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $428 | $256.8 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $551 | $330.6 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $735 | $441 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $961 | $576.6 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,334 | $800.4 | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,227 | $736.2 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,412 | $847.2 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $2,653 | $1,591.8 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,656 | $993.6 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $1,868 | $1,120.8 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $2,510 | $1,506 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $2,270 | $1,362 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $200 | $120 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $252 | $151.2 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $278 | $166.8 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,348 | $808.8 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,656 | $993.6 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,036 | $1,221.6 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $1,964 | $1,178.4 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $2,063 | $1,237.8 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $2,163 | $1,297.8 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $262 | $157.2 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $1,348 | $808.8 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $1,399 | $839.4 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $1,399 | $839.4 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $1,964 | $1,178.4 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $1,964 | $1,178.4 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $1,964 | $1,178.4 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $2,063 | $1,237.8 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $2,295 | $1,377 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $2,671 | $1,602.6 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,348 | $808.8 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $1,656 | $993.6 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $365 | $219 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $322 | $193.2 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $312 | $187.2 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $1,868 | $1,120.8 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $2,042 | $1,225.2 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $342 | $205.2 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $376 | $225.6 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $1,868 | $1,120.8 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $3,091 | $1,854.6 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,348 | $808.8 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $1,656 | $993.6 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,036 | $1,221.6 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $2,022 | $1,213.2 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $2,485 | $1,491 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $3,053 | $1,831.8 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $1,868 | $1,120.8 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $2,042 | $1,225.2 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $513 | $307.8 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $482 | $289.2 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $556 | $333.6 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $444 | $266.4 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $444 | $266.4 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $445 | $267 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $493 | $295.8 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $657 | $394.2 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $243 | $145.8 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $308 | $184.8 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $300 | $180 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $188 | $112.8 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,217 | $730.2 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,002 | $601.2 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $993 | $595.8 | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $45 | $27 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $74 | $44.4 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $60 | $36 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $60 | $36 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $79 | $47.4 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $40 | $24 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $35 | $21 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $31 | $18.6 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $35 | $21 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $50 | $30 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $65 | $39 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $40 | $24 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $30 | $18 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $40 | $24 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $47 | $28.2 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $201 | $120.6 | — | — | — |
| maternity |
| Fetal non-stress test | CPT | 59025 | 0 | $944 | $566.4 | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $270 | $162 | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $280 | $168 | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $293 | $175.8 | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $450 | $270 | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $260 | $156 | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $270 | $162 | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $280 | $168 | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $290 | $174 | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $314 | $188.4 | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,900 | $1,140 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,900 | $1,140 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,950 | $1,170 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $1,950 | $1,170 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $1,950 | $1,170 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,500 | $1,500 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $2,500 | $1,500 | — | — | — |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 0 | $9,998 | $5,998.8 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $15,185 | $9,111 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $15,185 | $9,111 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $6,794 | $4,076.4 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $6,794 | $4,076.4 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $6,794 | $4,076.4 | — | — | — |