| Psychotherapy 30 minutes | CPT 90832 | $60.63 |
| Psychotherapy 45 minutes | CPT 90834 | $80.67 |
| Psychotherapy 60 minutes | CPT 90837 | $100.4 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $104.73 |
| ED visit level 4 | CPT 99284 | $344.95 |
| CT head without contrast | CPT 70450 | $972.07 |
| CT head with contrast | CPT 70460 | $1,084.4 |
| CT head with and without contrast | CPT 70470 | $1,877.5 |
| CT neck with contrast | CPT 70491 | $1,089.2 |
| MRI brain without contrast | CPT 70551 | $1,984.5 |
| MRI brain with contrast | CPT 70552 | $2,067.42 |
| MRI brain with and without contrast | CPT 70553 | $3,620.07 |
| Chest X-ray single view | CPT 71045 | $68.97 |
| Chest X-ray 2 views | CPT 71046 | $124.08 |
| Chest X-ray 3 views | CPT 71047 | $202.92 |
| CT chest without contrast | CPT 71250 | $1,035.82 |
| CT chest with contrast | CPT 71260 | $1,089.2 |
| CT chest with and without contrast | CPT 71270 | $1,820.48 |
| MRI chest without contrast | CPT 71550 | $1,875.24 |
| MRI chest with contrast | CPT 71551 | $1,906.8 |
| MRI chest with and without contrast | CPT 71552 | $2,495.19 |
| Lumbosacral spine X-ray | CPT 72100 | $155.76 |
| CT cervical spine without contrast | CPT 72125 | $972.07 |
| CT thoracic spine without contrast | CPT 72128 | $972.07 |
| CT lumbar spine without contrast | CPT 72131 | $976.39 |
| MRI cervical spine without contrast | CPT 72141 | $1,868.19 |
| MRI thoracic spine without contrast | CPT 72146 | $1,671.05 |
| MRI lumbar spine without contrast | CPT 72148 | $1,822.5 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,031.48 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,058.44 |
| MRI lumbar spine with contrast | CPT 72158 | $3,062.22 |
| CT pelvis without contrast | CPT 72192 | $976.39 |
| CT pelvis with contrast | CPT 72193 | $1,089.2 |
| Shoulder X-ray | CPT 73030 | $161.11 |
| Humerus X-ray | CPT 73060 | $133.7 |
| Hand X-ray 3 views | CPT 73130 | $196.02 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,733.85 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,065.44 |
| Knee X-ray 1-2 views | CPT 73560 | $88.08 |
| Ankle X-ray 3 views | CPT 73610 | $104.09 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,472.92 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,364.93 |
| CT abdomen without contrast | CPT 74150 | $972.07 |
| CT abdomen with contrast | CPT 74160 | $1,089.2 |
| CT abdomen with and without contrast | CPT 74170 | $1,877.5 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,310.52 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,461.93 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,519.99 |
| MRI abdomen without contrast | CPT 74181 | $1,660.3 |
| MRI abdomen with and without contrast | CPT 74183 | $2,777.47 |
| Abdominal ultrasound complete | CPT 76700 | $573.36 |
| Abdominal ultrasound limited | CPT 76705 | $430.92 |
| Retroperitoneal ultrasound complete | CPT 76770 | $813.94 |
| Obstetric ultrasound first trimester | CPT 76801 | $539.16 |
| Obstetric ultrasound after first trimester | CPT 76805 | $492.12 |
| Transvaginal ultrasound | CPT 76830 | $698.22 |
| Pelvic ultrasound complete | CPT 76856 | $755.4 |
| Scrotal ultrasound | CPT 76870 | $605.46 |
| Diagnostic mammography unilateral | CPT 77065 | $296.7 |
| Diagnostic mammography bilateral | CPT 77066 | $346.97 |
| Screening mammography bilateral | CPT 77067 | $143.87 |
| EKG tracing only | CPT 93005 | $26.12 |
| Transthoracic echocardiogram complete | CPT 93306 | $789.36 |
| Transthoracic echocardiogram | CPT 93307 | $763.13 |
| Stress echocardiogram | CPT 93350 | $1,027.38 |
| Initial hospital care, low complexity | CPT 99221 | $82.75 |
| Basic metabolic panel (BMP) | CPT 80048 | $141.71 |
| Electrolyte panel | CPT 80051 | $30.84 |
| Comprehensive metabolic panel | CPT 80053 | $152.42 |
| Lipid panel | CPT 80061 | $125.09 |
| Renal function panel | CPT 80069 | $55.31 |
| Hepatic function panel | CPT 80076 | $39.89 |
| Urinalysis non-automated | CPT 81002 | $6.61 |
| Urinalysis automated | CPT 81003 | $12.09 |
| Glucose quantitative | CPT 82947 | $36.47 |
| Hemoglobin A1c | CPT 83036 | $20.11 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $122.83 |
| Complete blood count with automated differential | CPT 85025 | $23.53 |
| Complete blood count without differential | CPT 85027 | $17.33 |
| Urine culture bacterial | CPT 87086 | $47.04 |
| Urine culture identification | CPT 87088 | $10.67 |
| Tissue exam by pathologist level IV | CPT 88305 | $30.35 |
| Fetal non-stress test | CPT 59025 | $411.72 |
| Office visit, new patient, 15-29 min | CPT 99202 | $62.06 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $83.4 |
| Office visit, new patient, 45-59 min | CPT 99204 | $111.84 |
| Office visit, new patient, 60-74 min | CPT 99205 | $140.94 |
| Office visit, established patient, 5 min | CPT 99211 | $21.33 |
| Office visit, established patient, 10-19 min | CPT 99212 | $40.08 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $57.54 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $221.75 |
| Office visit, established patient, 40-54 min | CPT 99215 | $293.6 |
| Upper GI endoscopy diagnostic | CPT 43235 | $792.95 |
| Upper GI endoscopy with biopsy | CPT 43239 | $765.67 |
| Sigmoidoscopy diagnostic | CPT 45330 | $278.58 |
| Sigmoidoscopy with biopsy | CPT 45331 | $692.66 |
| Colonoscopy diagnostic | CPT 45378 | $1,014.11 |
| Colonoscopy with biopsy | CPT 45380 | $778.78 |
| Colonoscopy with polyp removal | CPT 45385 | $1,071 |
| Laparoscopic appendectomy | CPT 44970 | $4,799.02 |
| Laparoscopic cholecystectomy | CPT 47562 | $5,208.87 |
| Open umbilical hernia repair | CPT 49560 | $2,758 |
| Lap inguinal hernia repair | CPT 49650 | $2,335.99 |
| Lap incisional hernia repair | CPT 49652 | $4,186.5 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $6,626.67 |
| Lap salpingo-oophorectomy | CPT 58661 | $4,859.77 |
| PCI single major coronary artery | CPT 92920 | $2,683.82 |
| PCI with drug-eluting stent | CPT 92928 | $4,795.28 |
| PCI bypass graft | CPT 92937 | $4,795.28 |
| Left heart catheterization | CPT 93452 | $5,327.1 |
| Coronary angiography with cath | CPT 93455 | $4,686.24 |
| Coronary angiography with bypass cath | CPT 93458 | $5,340.74 |
