| Psychiatric diagnostic evaluation | CPT 90791 | $251.00 |
| Psychiatric eval with medical services | CPT 90792 | $251.00 |
| Psychotherapy 30 minutes | CPT 90832 | $152.00 |
| Psychotherapy 45 minutes | CPT 90834 | $216.00 |
| Psychotherapy 60 minutes | CPT 90837 | $216.00 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $313.48 |
| CT head without contrast | CPT 70450 | $979.45 |
| CT head with contrast | CPT 70460 | $1,318.17 |
| CT head with and without contrast | CPT 70470 | $1,572.01 |
| MRI brain without contrast | CPT 70551 | $2,411.54 |
| MRI brain with contrast | CPT 70552 | $2,642.45 |
| MRI brain with and without contrast | CPT 70553 | $3,378.00 |
| Chest X-ray single view | CPT 71045 | — |
| CT chest without contrast | CPT 71250 | $1,138.48 |
| CT chest with contrast | CPT 71260 | $1,494.02 |
| CT chest with and without contrast | CPT 71270 | $1,782.28 |
| Lumbosacral spine X-ray | CPT 72100 | — |
| CT cervical spine without contrast | CPT 72125 | $1,254.70 |
| MRI cervical spine without contrast | CPT 72141 | $1,835.80 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,215.90 |
| CT pelvis without contrast | CPT 72192 | $1,254.70 |
| CT pelvis with contrast | CPT 72193 | $1,647.71 |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | — |
| Hand X-ray 3 views | CPT 73130 | — |
| Knee X-ray 1-2 views | CPT 73560 | — |
| Ankle X-ray 3 views | CPT 73610 | — |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,274.68 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,186.08 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,930.80 |
| Abdominal ultrasound complete | CPT 76700 | $555.09 |
| Abdominal ultrasound limited | CPT 76705 | $541.33 |
| Retroperitoneal ultrasound complete | CPT 76770 | $555.09 |
| Pelvic ultrasound complete | CPT 76856 | $555.09 |
| Initial hospital care, low complexity | CPT 99221 | $206.44 |
| Initial hospital care, moderate complexity | CPT 99222 | $294.37 |
| Initial hospital care, high complexity | CPT 99223 | $444.99 |
| Hospital discharge, <30 min | CPT 99238 | $165.15 |
| Hospital discharge, >30 min | CPT 99239 | $274.49 |
| Basic metabolic panel (BMP) | CPT 80048 | — |
| General health panel | CPT 80050 | $53.28 |
| Electrolyte panel | CPT 80051 | $28.92 |
| Comprehensive metabolic panel | CPT 80053 | $48.71 |
| Lipid panel | CPT 80061 | — |
| Renal function panel | CPT 80069 | — |
| Hepatic function panel | CPT 80076 | — |
| Urinalysis non-automated | CPT 81002 | — |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | $32.72 |
| Hemoglobin A1c | CPT 83036 | — |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $140.80 |
| Complete blood count with automated differential | CPT 85025 | $38.06 |
| Complete blood count without differential | CPT 85027 | $25.87 |
| Urine culture bacterial | CPT 87086 | — |
| Urine culture identification | CPT 87088 | — |
| Office visit, new patient, 15-29 min | CPT 99202 | $388.36 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $456.76 |
| Office visit, new patient, 45-59 min | CPT 99204 | $628.52 |
| Office visit, new patient, 60-74 min | CPT 99205 | $742.52 |
| Office visit, established patient, 5 min | CPT 99211 | $164.16 |
| Office visit, established patient, 10-19 min | CPT 99212 | $241.68 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $340.48 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $462.84 |
| Office visit, established patient, 40-54 min | CPT 99215 | $585.20 |
