| Psychiatric diagnostic evaluation | CPT 90791 | $119.36 |
| Psychiatric eval with medical services | CPT 90792 | $529.01 |
| Psychotherapy 30 minutes | CPT 90832 | $119.36 |
| Psychotherapy 45 minutes | CPT 90834 | $119.36 |
| Psychotherapy 60 minutes | CPT 90837 | $317.40 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $317.40 |
| ED visit level 1 | CPT 99281 | $122.99 |
| ED visit level 2 | CPT 99282 | $122.99 |
| ED visit level 3 | CPT 99283 | $245.98 |
| ED visit level 4 | CPT 99284 | $491.97 |
| ED visit level 5 | CPT 99285 | $860.94 |
| CT head without contrast | CPT 70450 | $107.92 |
| CT head with contrast | CPT 70460 | $154.16 |
| CT head with and without contrast | CPT 70470 | $185.00 |
| CT neck with contrast | CPT 70491 | $241.52 |
| MRI brain without contrast | CPT 70551 | $501.39 |
| MRI brain with contrast | CPT 70552 | $740.69 |
| MRI brain with and without contrast | CPT 70553 | $843.24 |
| CT chest without contrast | CPT 71250 | $185.00 |
| CT chest with contrast | CPT 71260 | $241.52 |
| CT chest with and without contrast | CPT 71270 | $298.05 |
| MRI chest without contrast | CPT 71550 | $1,093.94 |
| MRI chest with contrast | CPT 71551 | $1,196.50 |
| MRI chest with and without contrast | CPT 71552 | $1,492.77 |
| Lumbosacral spine X-ray | CPT 72100 | $214.94 |
| CT cervical spine without contrast | CPT 72125 | $190.13 |
| CT thoracic spine without contrast | CPT 72128 | $185.00 |
| CT lumbar spine without contrast | CPT 72131 | $185.00 |
| MRI cervical spine without contrast | CPT 72141 | $478.60 |
| MRI thoracic spine without contrast | CPT 72146 | $478.60 |
| MRI lumbar spine without contrast | CPT 72148 | $478.60 |
| MRI lumbar spine with and without contrast | CPT 72149 | $740.69 |
| MRI cervical spine with and without contrast | CPT 72156 | $843.24 |
| MRI lumbar spine with contrast | CPT 72158 | $843.24 |
| CT pelvis without contrast | CPT 72192 | $133.61 |
| CT pelvis with contrast | CPT 72193 | $241.52 |
| Shoulder X-ray | CPT 73030 | $153.53 |
| Humerus X-ray | CPT 73060 | $184.23 |
| Hand X-ray 3 views | CPT 73130 | $184.23 |
| MRI upper extremity joint without contrast | CPT 73221 | $535.57 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,162.31 |
| Knee X-ray 1-2 views | CPT 73560 | $184.23 |
| Ankle X-ray 3 views | CPT 73610 | $184.23 |
| MRI lower extremity joint without contrast | CPT 73721 | $535.57 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,162.31 |
| CT abdomen without contrast | CPT 74150 | $128.47 |
| CT abdomen with contrast | CPT 74160 | $241.52 |
| CT abdomen with and without contrast | CPT 74170 | $277.49 |
| CT abdomen and pelvis without contrast | CPT 74176 | $164.44 |
| CT abdomen and pelvis with contrast | CPT 74177 | $318.61 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $364.85 |
| MRI abdomen without contrast | CPT 74181 | $831.85 |
| MRI abdomen with and without contrast | CPT 74183 | $1,264.86 |
| Abdominal ultrasound complete | CPT 76700 | $706.22 |
| Abdominal ultrasound limited | CPT 76705 | $552.70 |
| Retroperitoneal ultrasound complete | CPT 76770 | $675.52 |
| Obstetric ultrasound first trimester | CPT 76801 | $644.82 |
| Obstetric ultrasound after first trimester | CPT 76805 | $798.34 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $736.93 |
| Transvaginal ultrasound | CPT 76830 | $767.63 |
| Pelvic ultrasound complete | CPT 76856 | $644.82 |
| Scrotal ultrasound | CPT 76870 | $307.05 |
| Diagnostic mammography unilateral | CPT 77065 | $61.41 |
| EKG tracing only | CPT 93005 | $52.16 |
| Transthoracic echocardiogram complete | CPT 93306 | $260.81 |
| Transthoracic echocardiogram | CPT 93307 | $195.60 |
| Stress echocardiogram | CPT 93350 | $260.81 |
| Initial hospital care, low complexity | CPT 99221 | $182.61 |
| Initial hospital care, moderate complexity | CPT 99222 | $288.16 |
| Initial hospital care, high complexity | CPT 99223 | $381.93 |
| Basic metabolic panel (BMP) | CPT 80048 | $30.81 |
| Electrolyte panel | CPT 80051 | $22.41 |
| Comprehensive metabolic panel | CPT 80053 | $42.01 |
| Lipid panel | CPT 80061 | $53.20 |
| Renal function panel | CPT 80069 | $33.60 |
| Hepatic function panel | CPT 80076 | $30.81 |
| Urinalysis non-automated | CPT 81002 | $11.20 |
| Urinalysis automated | CPT 81003 | $11.20 |
| Glucose quantitative | CPT 82947 | $11.20 |
| Hemoglobin A1c | CPT 83036 | $56.01 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $42.01 |
| Complete blood count with automated differential | CPT 85025 | $28.00 |
| Complete blood count without differential | CPT 85027 | $22.41 |
| Urine culture bacterial | CPT 87086 | $56.01 |
| Urine culture identification | CPT 87088 | $84.01 |
| Tissue exam by pathologist level IV | CPT 88305 | $168.02 |
| Office visit, new patient, 15-29 min | CPT 99202 | $105.80 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $141.07 |
| Office visit, new patient, 45-59 min | CPT 99204 | $176.34 |
| Office visit, new patient, 60-74 min | CPT 99205 | $211.61 |
| Office visit, established patient, 5 min | CPT 99211 | $70.54 |
| Office visit, established patient, 10-19 min | CPT 99212 | $105.80 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $141.07 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $176.34 |
| Office visit, established patient, 40-54 min | CPT 99215 | $211.61 |
