| Psychiatric diagnostic evaluation | CPT 90791 | $200.00 |
| Psychotherapy 30 minutes | CPT 90832 | $116.00 |
| Psychotherapy 45 minutes | CPT 90834 | $158.00 |
| ED visit level 1 | CPT 99281 | $191.50 |
| ED visit level 2 | CPT 99282 | $314.00 |
| ED visit level 3 | CPT 99283 | $492.00 |
| ED visit level 4 | CPT 99284 | $717.50 |
| ED visit level 5 | CPT 99285 | $1,144.00 |
| Critical care, first hour | CPT 99291 | $1,654.00 |
| CT head without contrast | CPT 70450 | $2,229.50 |
| CT head with contrast | CPT 70460 | $2,523.00 |
| CT head with and without contrast | CPT 70470 | $3,064.50 |
| CT neck with contrast | CPT 70491 | $2,840.00 |
| MRI brain without contrast | CPT 70551 | $4,020.00 |
| MRI brain with contrast | CPT 70552 | $4,444.50 |
| MRI brain with and without contrast | CPT 70553 | $5,248.50 |
| Chest X-ray single view | CPT 71045 | $279.00 |
| Chest X-ray 2 views | CPT 71046 | $374.50 |
| Chest X-ray 3 views | CPT 71047 | $500.00 |
| CT chest without contrast | CPT 71250 | $2,511.00 |
| CT chest with contrast | CPT 71260 | $2,776.00 |
| CT chest with and without contrast | CPT 71270 | $3,194.50 |
| MRI chest without contrast | CPT 71550 | $4,157.50 |
| Lumbosacral spine X-ray | CPT 72100 | $488.00 |
| CT cervical spine without contrast | CPT 72125 | $2,615.00 |
| CT thoracic spine without contrast | CPT 72128 | $2,463.50 |
| CT lumbar spine without contrast | CPT 72131 | $2,512.00 |
| MRI cervical spine without contrast | CPT 72141 | $3,667.50 |
| MRI thoracic spine without contrast | CPT 72146 | $3,760.50 |
| MRI lumbar spine without contrast | CPT 72148 | $3,633.00 |
| MRI lumbar spine with and without contrast | CPT 72149 | $4,056.50 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,810.00 |
| MRI lumbar spine with contrast | CPT 72158 | $4,768.50 |
| CT pelvis without contrast | CPT 72192 | $2,463.50 |
| CT pelvis with contrast | CPT 72193 | $2,771.00 |
| Shoulder X-ray | CPT 73030 | $412.50 |
| Humerus X-ray | CPT 73060 | $354.50 |
| Hand X-ray 3 views | CPT 73130 | $343.00 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,834.00 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,213.50 |
| Knee X-ray 1-2 views | CPT 73560 | $378.50 |
| Ankle X-ray 3 views | CPT 73610 | $363.50 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,880.50 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,708.00 |
| CT abdomen without contrast | CPT 74150 | $3,672.50 |
| CT abdomen with contrast | CPT 74160 | $4,029.50 |
| CT abdomen with and without contrast | CPT 74170 | $4,721.50 |
| CT abdomen and pelvis without contrast | CPT 74176 | $4,591.50 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,039.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,901.00 |
| MRI abdomen without contrast | CPT 74181 | $3,442.00 |
| MRI abdomen with and without contrast | CPT 74183 | $4,477.50 |
| Abdominal ultrasound complete | CPT 76700 | $893.50 |
| Abdominal ultrasound limited | CPT 76705 | $722.50 |
| Retroperitoneal ultrasound complete | CPT 76770 | $783.50 |
| Obstetric ultrasound first trimester | CPT 76801 | $769.50 |
| Obstetric ultrasound after first trimester | CPT 76805 | $864.50 |
| Transvaginal ultrasound | CPT 76830 | $731.00 |
| Pelvic ultrasound complete | CPT 76856 | $826.00 |
| Scrotal ultrasound | CPT 76870 | $719.50 |
| EKG tracing only | CPT 93005 | $338.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,237.00 |
| Stress echocardiogram | CPT 93350 | $1,659.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $189.00 |
| Electrolyte panel | CPT 80051 | $153.00 |
| Comprehensive metabolic panel | CPT 80053 | $236.00 |
| Lipid panel | CPT 80061 | $140.50 |
| Renal function panel | CPT 80069 | $175.50 |
| Hepatic function panel | CPT 80076 | $170.00 |
| Urinalysis non-automated | CPT 81002 | $27.00 |
| Urinalysis automated | CPT 81003 | $55.50 |
| Glucose quantitative | CPT 82947 | $77.00 |
| Hemoglobin A1c | CPT 83036 | $93.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $140.50 |
| Complete blood count with automated differential | CPT 85025 | $123.50 |
| Complete blood count without differential | CPT 85027 | $119.50 |
| Urine culture identification | CPT 87088 | $119.50 |
| Tissue exam by pathologist level IV | CPT 88305 | $322.50 |
| Vaginal delivery only | CPT 59409 | $4,122.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $148.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $210.50 |
| Office visit, new patient, 45-59 min | CPT 99204 | $323.50 |
| Office visit, new patient, 60-74 min | CPT 99205 | $406.00 |
| Office visit, established patient, 5 min | CPT 99211 | $48.50 |
| Office visit, established patient, 10-19 min | CPT 99212 | $86.50 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $143.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $210.50 |
| Office visit, established patient, 40-54 min | CPT 99215 | $287.50 |
| Upper GI endoscopy diagnostic | CPT 43235 | $475.50 |
| Upper GI endoscopy with biopsy | CPT 43239 | $621.50 |
| Colonoscopy with biopsy | CPT 45380 | $716.50 |
