| Psychiatric diagnostic evaluation | CPT 90791 | $224.61 |
| Psychiatric eval with medical services | CPT 90792 | $224.61 |
| Psychotherapy 30 minutes | CPT 90832 | $114.38 |
| Psychotherapy 45 minutes | CPT 90834 | $148.11 |
| Psychotherapy 60 minutes | CPT 90837 | $135.8 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $185.6 |
| ED visit level 1 | CPT 99281 | $152.63 |
| ED visit level 2 | CPT 99282 | $244.2 |
| ED visit level 3 | CPT 99283 | $405.91 |
| ED visit level 4 | CPT 99284 | $656.29 |
| ED visit level 5 | CPT 99285 | $1,154.26 |
| Critical care, first hour | CPT 99291 | $1,493.64 |
| CT head without contrast | CPT 70450 | $477.57 |
| CT head with contrast | CPT 70460 | $546.52 |
| CT head with and without contrast | CPT 70470 | $738.06 |
| CT neck with contrast | CPT 70491 | $531.97 |
| MRI brain without contrast | CPT 70551 | $769.11 |
| MRI brain with contrast | CPT 70552 | $965.36 |
| MRI brain with and without contrast | CPT 70553 | $1,097.5 |
| Chest X-ray single view | CPT 71045 | $149.04 |
| Chest X-ray 2 views | CPT 71046 | $141.95 |
| Chest X-ray 3 views | CPT 71047 | $238.71 |
| CT chest without contrast | CPT 71250 | $1,016.21 |
| CT chest with contrast | CPT 71260 | $925.85 |
| CT chest with and without contrast | CPT 71270 | $1,030.47 |
| MRI chest without contrast | CPT 71550 | $1,034.78 |
| MRI chest with contrast | CPT 71551 | $1,205.31 |
| MRI chest with and without contrast | CPT 71552 | $1,346.13 |
| Lumbosacral spine X-ray | CPT 72100 | $152.52 |
| CT cervical spine without contrast | CPT 72125 | $744.14 |
| CT thoracic spine without contrast | CPT 72128 | $656.29 |
| CT lumbar spine without contrast | CPT 72131 | $859.4 |
| MRI cervical spine without contrast | CPT 72141 | $902.36 |
| MRI thoracic spine without contrast | CPT 72146 | $876.49 |
| MRI lumbar spine without contrast | CPT 72148 | $915.05 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,039.79 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,675.82 |
| MRI lumbar spine with contrast | CPT 72158 | $1,675.82 |
| CT pelvis without contrast | CPT 72192 | $578.14 |
| CT pelvis with contrast | CPT 72193 | $914.2 |
| Shoulder X-ray | CPT 73030 | $97.96 |
| Humerus X-ray | CPT 73060 | $118.78 |
| Hand X-ray 3 views | CPT 73130 | $139.96 |
| MRI upper extremity joint without contrast | CPT 73221 | $959.59 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,252.57 |
| Knee X-ray 1-2 views | CPT 73560 | $82.63 |
| Ankle X-ray 3 views | CPT 73610 | $128.34 |
| MRI lower extremity joint without contrast | CPT 73721 | $604.86 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,146.4 |
| CT abdomen without contrast | CPT 74150 | $516.47 |
| CT abdomen with contrast | CPT 74160 | $645.58 |
| CT abdomen with and without contrast | CPT 74170 | $832.67 |
| CT abdomen and pelvis without contrast | CPT 74176 | $738.28 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,008.8 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,129.28 |
| MRI abdomen without contrast | CPT 74181 | $805.2 |
| MRI abdomen with and without contrast | CPT 74183 | $1,183.56 |
| Abdominal ultrasound complete | CPT 76700 | $235.29 |
| Abdominal ultrasound limited | CPT 76705 | $156.29 |
| Retroperitoneal ultrasound complete | CPT 76770 | $232.42 |
| Obstetric ultrasound first trimester | CPT 76801 | $274.04 |
| Obstetric ultrasound after first trimester | CPT 76805 | $276.83 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $304.78 |
| Transvaginal ultrasound | CPT 76830 | $246.2 |
| Pelvic ultrasound complete | CPT 76856 | $274.04 |
| Scrotal ultrasound | CPT 76870 | $229.59 |
| Diagnostic mammography unilateral | CPT 77065 | $178.54 |
| Diagnostic mammography bilateral | CPT 77066 | $200.61 |
| Screening mammography bilateral | CPT 77067 | $167.43 |
| EKG tracing only | CPT 93005 | $98.7 |
| Transthoracic echocardiogram complete | CPT 93306 | $636.94 |
| Transthoracic echocardiogram | CPT 93307 | $353.45 |
| Stress echocardiogram | CPT 93350 | $519.43 |
| Basic metabolic panel (BMP) | CPT 80048 | $55.69 |
| Electrolyte panel | CPT 80051 | $19.42 |
| Comprehensive metabolic panel | CPT 80053 | $62.09 |
| Lipid panel | CPT 80061 | $31.93 |
| Renal function panel | CPT 80069 | $60.07 |
| Hepatic function panel | CPT 80076 | $74.89 |
| Urinalysis non-automated | CPT 81002 | $7.66 |
| Urinalysis automated | CPT 81003 | $21.68 |
| Glucose quantitative | CPT 82947 | $13.71 |
| Hemoglobin A1c | CPT 83036 | $51.25 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $58.06 |
| Complete blood count with automated differential | CPT 85025 | $28.32 |
| Complete blood count without differential | CPT 85027 | $32.86 |
| Urine culture bacterial | CPT 87086 | $30.51 |
| Tissue exam by pathologist level IV | CPT 88305 | $123.02 |
| Fetal non-stress test | CPT 59025 | $209.26 |
| Office visit, new patient, 15-29 min | CPT 99202 | $63.43 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $70.59 |
| Office visit, new patient, 45-59 min | CPT 99204 | $82.41 |
| Office visit, new patient, 60-74 min | CPT 99205 | $100.63 |
| Office visit, established patient, 5 min | CPT 99211 | $42.99 |
| Office visit, established patient, 10-19 min | CPT 99212 | $49.45 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $61.62 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $75.22 |
| Office visit, established patient, 40-54 min | CPT 99215 | $85.52 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,025.3 |
| Sigmoidoscopy with biopsy | CPT 45331 | $954.83 |
| Intravitreal injection | CPT 67028 | $476.95 |
