| Psychiatric diagnostic evaluation | CPT 90791 | $298.25 |
| Psychotherapy 30 minutes | CPT 90832 | $258 |
| Psychotherapy 45 minutes | CPT 90834 | $180.5 |
| Psychotherapy 60 minutes | CPT 90837 | $258 |
| ED visit level 1 | CPT 99281 | $162.4 |
| ED visit level 2 | CPT 99282 | $364.35 |
| ED visit level 3 | CPT 99283 | $684.6 |
| ED visit level 4 | CPT 99284 | $726.95 |
| ED visit level 5 | CPT 99285 | $983.85 |
| Critical care, first hour | CPT 99291 | $1,675.45 |
| CT head without contrast | CPT 70450 | $765 |
| CT head with contrast | CPT 70460 | $861.22 |
| CT head with and without contrast | CPT 70470 | $939.89 |
| CT neck with contrast | CPT 70491 | $765.22 |
| MRI brain without contrast | CPT 70551 | $998.22 |
| MRI brain with contrast | CPT 70552 | $1,129.74 |
| MRI brain with and without contrast | CPT 70553 | $1,260.93 |
| Chest X-ray single view | CPT 71045 | $373.97 |
| Chest X-ray 2 views | CPT 71046 | $422.52 |
| Chest X-ray 3 views | CPT 71047 | $342.76 |
| CT chest without contrast | CPT 71250 | $704.52 |
| CT chest with contrast | CPT 71260 | $807.62 |
| CT chest with and without contrast | CPT 71270 | $910.83 |
| MRI chest without contrast | CPT 71550 | $1,372.33 |
| MRI chest with contrast | CPT 71551 | $1,448.53 |
| MRI chest with and without contrast | CPT 71552 | $2,202.54 |
| Lumbosacral spine X-ray | CPT 72100 | $875.09 |
| CT cervical spine without contrast | CPT 72125 | $935.8 |
| CT thoracic spine without contrast | CPT 72128 | $860.14 |
| CT lumbar spine without contrast | CPT 72131 | $912.66 |
| MRI cervical spine without contrast | CPT 72141 | $995.64 |
| MRI thoracic spine without contrast | CPT 72146 | $1,143.84 |
| MRI lumbar spine without contrast | CPT 72148 | $1,143.84 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,259.21 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,194.64 |
| MRI lumbar spine with contrast | CPT 72158 | $1,372.33 |
| CT pelvis without contrast | CPT 72192 | $656.73 |
| CT pelvis with contrast | CPT 72193 | $767.8 |
| Shoulder X-ray | CPT 73030 | $459.41 |
| Humerus X-ray | CPT 73060 | $413.85 |
| Hand X-ray 3 views | CPT 73130 | $458.64 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,715.76 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,523.43 |
| Knee X-ray 1-2 views | CPT 73560 | $469.91 |
| Ankle X-ray 3 views | CPT 73610 | $622.51 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,715.76 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,241.72 |
| CT abdomen without contrast | CPT 74150 | $499.27 |
| CT abdomen with contrast | CPT 74160 | $891.57 |
| CT abdomen with and without contrast | CPT 74170 | $1,014.48 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,419.79 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,659.25 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,906.58 |
| MRI abdomen without contrast | CPT 74181 | $1,372.33 |
| MRI abdomen with and without contrast | CPT 74183 | $1,525.05 |
| Abdominal ultrasound complete | CPT 76700 | $632.63 |
| Abdominal ultrasound limited | CPT 76705 | $478.47 |
| Retroperitoneal ultrasound complete | CPT 76770 | $390.32 |
| Obstetric ultrasound first trimester | CPT 76801 | $605.57 |
| Obstetric ultrasound after first trimester | CPT 76805 | $554.32 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $313.65 |
| Transvaginal ultrasound | CPT 76830 | $603.93 |
| Pelvic ultrasound complete | CPT 76856 | $605.57 |
| Scrotal ultrasound | CPT 76870 | $441.98 |
| Diagnostic mammography unilateral | CPT 77065 | $292.74 |
| Diagnostic mammography bilateral | CPT 77066 | $322.67 |
| Screening mammography bilateral | CPT 77067 | $256.66 |
| EKG tracing only | CPT 93005 | $255 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,057 |
| Transthoracic echocardiogram | CPT 93307 | $355.81 |
| Stress echocardiogram | CPT 93350 | $2,557 |
| Basic metabolic panel (BMP) | CPT 80048 | $68.56 |
| General health panel | CPT 80050 | $248.05 |
| Electrolyte panel | CPT 80051 | $55.1 |
| Comprehensive metabolic panel | CPT 80053 | $73.72 |
| Lipid panel | CPT 80061 | $60.92 |
| Renal function panel | CPT 80069 | $73.4 |
| Hepatic function panel | CPT 80076 | $67.16 |
| Urinalysis non-automated | CPT 81002 | $8.61 |
| Urinalysis automated | CPT 81003 | $14.21 |
| Glucose quantitative | CPT 82947 | $33.37 |
| Hemoglobin A1c | CPT 83036 | $30.24 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $37.67 |
| Complete blood count with automated differential | CPT 85025 | $19.7 |
| Complete blood count without differential | CPT 85027 | $19.7 |
| Urine culture bacterial | CPT 87086 | $24.65 |
| Urine culture identification | CPT 87088 | $49.72 |
| Tissue exam by pathologist level IV | CPT 88305 | $90.73 |
| Fetal non-stress test | CPT 59025 | $466.99 |
| Office visit, established patient, 5 min | CPT 99211 | $168.51 |
| Upper GI endoscopy diagnostic | CPT 43235 | $490.77 |
| Upper GI endoscopy with biopsy | CPT 43239 | $702.74 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,015.57 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,354.23 |
| Colonoscopy diagnostic | CPT 45378 | $831.48 |
| Colonoscopy with biopsy | CPT 45380 | $1,085.68 |
| Colonoscopy with polyp removal | CPT 45385 | $1,026.23 |
| PCI single major coronary artery | CPT 92920 | $10,717 |
| PCI with drug-eluting stent | CPT 92928 | $17,797 |
| PCI bypass graft | CPT 92937 | $27,678 |
| Coronary angiography with cath | CPT 93455 | $4,767.49 |
| Coronary angiography with bypass cath | CPT 93458 | $5,592.86 |
