| behavioral |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $1,475 | $253.11 | — | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $1,536 | $263.58 | — | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $1,243 | $213.3 | — | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $1,308 | $224.45 | — | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $1,433 | $245.9 | — | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $1,420 | $243.67 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $532 | $91.29 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $890 | $152.72 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $890 | $152.72 | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $440 | $75.5 | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $440 | $75.5 | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $440 | $75.5 | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $1,209 | $207.46 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $386 | $66.24 | — | — | — | — |
| inpatient |
| Initial hospital care, high complexity | CPT | 99223 | 0 | $493 | $84.6 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $55 | $9.44 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $383 | $65.72 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $69 | $11.84 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $87 | $14.93 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $56 | $9.61 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $53 | $9.09 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $15 | $2.57 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $26 | $4.46 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $63 | $10.81 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $109 | $18.7 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $51 | $8.75 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $42 | $7.21 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $52 | $8.92 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $53 | $9.09 | — | — | — | — |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 0 | $250 | $42.9 | — | — | — | — |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 0 | $349 | $59.89 | — | — | — | — |
| Office visit, new patient, 45-59 min | CPT | 99204 | 0 | $495 | $84.94 | — | — | — | — |
| Office visit, new patient, 60-74 min | CPT | 99205 | 0 | $632 | $108.45 | — | — | — | — |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $140 | $24.02 | — | — | — | — |
| Office visit, established patient, 10-19 min | CPT | 99212 | 0 | $216 | $37.07 | — | — | — | — |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 0 | $303 | $51.99 | — | — | — | — |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 0 | $392 | $67.27 | — | — | — | — |
| Office visit, established patient, 40-54 min | CPT | 99215 | 0 | $526 | $90.26 | — | — | — | — |
