| Psychiatric diagnostic evaluation | CPT 90791 | $168.00 |
| Psychiatric eval with medical services | CPT 90792 | $208.80 |
| Psychotherapy 30 minutes | CPT 90832 | $64.00 |
| Psychotherapy 45 minutes | CPT 90834 | $88.00 |
| Psychotherapy 60 minutes | CPT 90837 | $129.60 |
| ED visit level 1 | CPT 99281 | $119.96 |
| ED visit level 2 | CPT 99282 | $237.63 |
| ED visit level 3 | CPT 99283 | $352.20 |
| ED visit level 4 | CPT 99284 | $466.01 |
| ED visit level 5 | CPT 99285 | $581.36 |
| Critical care, first hour | CPT 99291 | $680.00 |
| CT head without contrast | CPT 70450 | $1,307.30 |
| CT head with contrast | CPT 70460 | $1,668.73 |
| CT head with and without contrast | CPT 70470 | $1,777.93 |
| CT neck with contrast | CPT 70491 | $1,668.73 |
| MRI brain without contrast | CPT 70551 | $1,832.53 |
| MRI brain with contrast | CPT 70552 | $2,237.03 |
| MRI brain with and without contrast | CPT 70553 | $2,540.78 |
| Chest X-ray single view | CPT 71045 | $152.26 |
| Chest X-ray 2 views | CPT 71046 | $267.61 |
| Chest X-ray 3 views | CPT 71047 | $146.88 |
| CT chest without contrast | CPT 71250 | $1,307.30 |
| CT chest with contrast | CPT 71260 | $1,831.76 |
| CT chest with and without contrast | CPT 71270 | $1,936.34 |
| MRI chest without contrast | CPT 71550 | $3,768.10 |
| Lumbosacral spine X-ray | CPT 72100 | $220.71 |
| CT cervical spine without contrast | CPT 72125 | $1,307.30 |
| CT thoracic spine without contrast | CPT 72128 | $1,307.30 |
| CT lumbar spine without contrast | CPT 72131 | $1,365.74 |
| MRI cervical spine without contrast | CPT 72141 | $1,832.53 |
| MRI thoracic spine without contrast | CPT 72146 | $1,832.53 |
| MRI lumbar spine without contrast | CPT 72148 | $1,832.53 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,237.03 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,540.78 |
| MRI lumbar spine with contrast | CPT 72158 | $2,540.78 |
| CT pelvis without contrast | CPT 72192 | $1,260.40 |
| CT pelvis with contrast | CPT 72193 | $1,831.76 |
| Shoulder X-ray | CPT 73030 | $250.69 |
| Humerus X-ray | CPT 73060 | $177.64 |
| Hand X-ray 3 views | CPT 73130 | $197.64 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,832.53 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,540.78 |
| Knee X-ray 1-2 views | CPT 73560 | $188.41 |
| Ankle X-ray 3 views | CPT 73610 | $177.64 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,832.53 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,540.78 |
| CT abdomen without contrast | CPT 74150 | $1,307.30 |
| CT abdomen with contrast | CPT 74160 | $1,831.76 |
| CT abdomen with and without contrast | CPT 74170 | $1,936.34 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,522.32 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,806.40 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,104.80 |
| MRI abdomen without contrast | CPT 74181 | $1,832.53 |
| MRI abdomen with and without contrast | CPT 74183 | $2,540.78 |
| Abdominal ultrasound complete | CPT 76700 | $516.77 |
| Abdominal ultrasound limited | CPT 76705 | $319.14 |
| Retroperitoneal ultrasound complete | CPT 76770 | $449.87 |
| Obstetric ultrasound after first trimester | CPT 76805 | $559.07 |
| Transvaginal ultrasound | CPT 76830 | $364.51 |
| Pelvic ultrasound complete | CPT 76856 | $461.40 |
| Scrotal ultrasound | CPT 76870 | $393.73 |
| Diagnostic mammography unilateral | CPT 77065 | $239.93 |
| Diagnostic mammography bilateral | CPT 77066 | $445.26 |
| Screening mammography bilateral | CPT 77067 | $295.30 |
| EKG complete | CPT 93000 | $242.24 |
| EKG tracing only | CPT 93005 | $197.64 |
| EKG interpretation only | CPT 93010 | $50.40 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,443.88 |
| Initial hospital care, low complexity | CPT 99221 | $224.00 |
| Initial hospital care, moderate complexity | CPT 99222 | $302.40 |
| Initial hospital care, high complexity | CPT 99223 | $441.60 |
| Hospital discharge, <30 min | CPT 99238 | $164.80 |
| Hospital discharge, >30 min | CPT 99239 | $229.60 |
| Basic metabolic panel (BMP) | CPT 80048 | $169.18 |
| General health panel | CPT 80050 | $336.82 |
| Electrolyte panel | CPT 80051 | $160.73 |
| Comprehensive metabolic panel | CPT 80053 | $217.63 |
| Lipid panel | CPT 80061 | $174.57 |
| Renal function panel | CPT 80069 | $186.10 |
| Hepatic function panel | CPT 80076 | $177.64 |
| Urinalysis non-automated | CPT 81002 | $22.40 |
| Urinalysis automated | CPT 81003 | $69.16 |
| Glucose quantitative | CPT 82947 | $78.38 |
| Hemoglobin A1c | CPT 83036 | $94.59 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $182.26 |
| Complete blood count with automated differential | CPT 85025 | $117.66 |
| Urine culture bacterial | CPT 87086 | $87.67 |
| Tissue exam by pathologist level IV | CPT 88305 | $201.48 |
| Office visit, new patient, 15-29 min | CPT 99202 | $144.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $186.40 |
| Office visit, new patient, 45-59 min | CPT 99204 | $266.40 |
| Office visit, new patient, 60-74 min | CPT 99205 | $312.80 |
| Office visit, established patient, 5 min | CPT 99211 | $92.80 |
| Office visit, established patient, 10-19 min | CPT 99212 | $80.80 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $104.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $150.40 |
| Office visit, established patient, 40-54 min | CPT 99215 | $323.20 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,153.60 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,432.80 |
| Sigmoidoscopy diagnostic | CPT 45330 | $514.40 |
| Sigmoidoscopy with biopsy | CPT 45331 | $581.60 |
| Colonoscopy diagnostic | CPT 45378 | $1,612.00 |
| Colonoscopy with biopsy | CPT 45380 | $1,942.40 |
| Colonoscopy with polyp removal | CPT 45385 | $2,016.00 |
| Laparoscopic appendectomy | CPT 44970 | $3,130.40 |
| Laparoscopic cholecystectomy | CPT 47562 | $3,920.00 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $4,182.40 |
| Open umbilical hernia repair | CPT 49560 | $2,878.40 |
| Umbilical hernia repair age 5+ | CPT 49585 | $2,259.20 |
| Lap inguinal hernia repair | CPT 49650 | $1,844.00 |
| Lap incisional hernia repair | CPT 49652 | $3,364.00 |