| Psychiatric diagnostic evaluation | CPT 90791 | $149.12 |
| Psychiatric eval with medical services | CPT 90792 | $169.43 |
| Psychotherapy 30 minutes | CPT 90832 | $65.72 |
| Psychotherapy 45 minutes | CPT 90834 | $87.11 |
| Psychotherapy 60 minutes | CPT 90837 | $128.07 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $582.91 |
| ED visit level 1 | CPT 99281 | $51.36 |
| ED visit level 2 | CPT 99282 | $51.36 |
| ED visit level 3 | CPT 99283 | $51.36 |
| ED visit level 4 | CPT 99284 | $3,900 |
| ED visit level 5 | CPT 99285 | — |
| Critical care, first hour | CPT 99291 | $7,800 |
| CT head without contrast | CPT 70450 | — |
| CT head with contrast | CPT 70460 | $156.38 |
| CT head with and without contrast | CPT 70470 | $178.55 |
| CT neck with contrast | CPT 70491 | $178.55 |
| MRI brain without contrast | CPT 70551 | $211.18 |
| MRI brain with contrast | CPT 70552 | $294.04 |
| MRI brain with and without contrast | CPT 70553 | $347.16 |
| Chest X-ray single view | CPT 71045 | — |
| Chest X-ray 2 views | CPT 71046 | — |
| Chest X-ray 3 views | CPT 71047 | $41.44 |
| CT chest without contrast | CPT 71250 | $108.97 |
| CT chest with contrast | CPT 71260 | $178.55 |
| CT chest with and without contrast | CPT 71270 | $178.55 |
| MRI chest without contrast | CPT 71550 | $230.13 |
| MRI chest with contrast | CPT 71551 | $417.66 |
| MRI chest with and without contrast | CPT 71552 | $368.12 |
| Lumbosacral spine X-ray | CPT 72100 | — |
| CT cervical spine without contrast | CPT 72125 | $108.97 |
| CT thoracic spine without contrast | CPT 72128 | $108.97 |
| CT lumbar spine without contrast | CPT 72131 | $108.97 |
| MRI cervical spine without contrast | CPT 72141 | $206.49 |
| MRI thoracic spine without contrast | CPT 72146 | $206.49 |
| MRI lumbar spine without contrast | CPT 72148 | $206.83 |
| MRI lumbar spine with and without contrast | CPT 72149 | $296.38 |
| MRI cervical spine with and without contrast | CPT 72156 | $350.5 |
| MRI lumbar spine with contrast | CPT 72158 | $349.84 |
| CT pelvis without contrast | CPT 72192 | $108.97 |
| CT pelvis with contrast | CPT 72193 | $178.55 |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | $31.41 |
| Hand X-ray 3 views | CPT 73130 | $35.41 |
| MRI upper extremity joint without contrast | CPT 73221 | $219.19 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $368.12 |
| Knee X-ray 1-2 views | CPT 73560 | — |
| Ankle X-ray 3 views | CPT 73610 | — |
| MRI lower extremity joint without contrast | CPT 73721 | $218.53 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $368.12 |
| CT abdomen without contrast | CPT 74150 | — |
| CT abdomen with contrast | CPT 74160 | $178.55 |
| CT abdomen with and without contrast | CPT 74170 | $178.55 |
| CT abdomen and pelvis without contrast | CPT 74176 | $192.13 |
| CT abdomen and pelvis with contrast | CPT 74177 | $324.78 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $364.2 |
| MRI abdomen without contrast | CPT 74181 | $213.51 |
| MRI abdomen with and without contrast | CPT 74183 | $368.12 |
| Abdominal ultrasound complete | CPT 76700 | $108.97 |
| Abdominal ultrasound limited | CPT 76705 | — |
| Retroperitoneal ultrasound complete | CPT 76770 | — |
| Pelvic ultrasound complete | CPT 76856 | $582.91 |
| Scrotal ultrasound | CPT 76870 | $102.91 |
| EKG tracing only | CPT 93005 | $582.91 |
| Transthoracic echocardiogram complete | CPT 93306 | $582.91 |
| Transthoracic echocardiogram | CPT 93307 | $132.65 |
| Basic metabolic panel (BMP) | CPT 80048 | $7.11 |
| Electrolyte panel | CPT 80051 | $5.89 |
| Comprehensive metabolic panel | CPT 80053 | $8.87 |
| Lipid panel | CPT 80061 | $11.25 |
| Renal function panel | CPT 80069 | $7.29 |
| Hepatic function panel | CPT 80076 | $6.86 |
| Urinalysis non-automated | CPT 81002 | — |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | — |
| Hemoglobin A1c | CPT 83036 | $8.16 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | — |
| Complete blood count with automated differential | CPT 85025 | — |
| Complete blood count without differential | CPT 85027 | $5.43 |
| Urine culture bacterial | CPT 87086 | $6.78 |
| Tissue exam by pathologist level IV | CPT 88305 | $582.91 |
| Office visit, new patient, 15-29 min | CPT 99202 | — |
| Office visit, new patient, 30-44 minutes | CPT 99203 | — |
| Office visit, new patient, 45-59 min | CPT 99204 | — |
| Office visit, new patient, 60-74 min | CPT 99205 | — |
| Office visit, established patient, 5 min | CPT 99211 | — |
| Office visit, established patient, 10-19 min | CPT 99212 | $582.91 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | — |
| Office visit, established patient, 30-39 minutes | CPT 99214 | — |
| Office visit, established patient, 40-54 min | CPT 99215 | — |
| Sigmoidoscopy with biopsy | CPT 45331 | $582.91 |
| Intravitreal injection | CPT 67028 | $582.91 |
| Left heart catheterization | CPT 93452 | $7,166 |
| Coronary angiography with cath | CPT 93455 | $7,166 |
| Coronary angiography with bypass cath | CPT 93458 | $7,166 |
