| Psychotherapy 30 minutes | CPT 90832 | $372.84 |
| Psychotherapy 45 minutes | CPT 90834 | $372.84 |
| Psychotherapy 60 minutes | CPT 90837 | $372.84 |
| ED visit level 1 | CPT 99281 | $225.28 |
| ED visit level 2 | CPT 99282 | $367.47 |
| ED visit level 3 | CPT 99283 | $720.88 |
| ED visit level 4 | CPT 99284 | $1,175.37 |
| ED visit level 5 | CPT 99285 | $1,422.70 |
| Critical care, first hour | CPT 99291 | $1,955.28 |
| CT head without contrast | CPT 70450 | $1,013.48 |
| CT head with contrast | CPT 70460 | $1,281.31 |
| CT head with and without contrast | CPT 70470 | $1,519.14 |
| CT neck with contrast | CPT 70491 | $1,281.31 |
| MRI brain without contrast | CPT 70551 | $1,537.93 |
| MRI brain with contrast | CPT 70552 | $1,668.80 |
| MRI brain with and without contrast | CPT 70553 | $1,982.60 |
| Chest X-ray single view | CPT 71045 | $238.99 |
| Chest X-ray 2 views | CPT 71046 | $238.99 |
| Chest X-ray 3 views | CPT 71047 | $238.99 |
| CT chest without contrast | CPT 71250 | $1,013.48 |
| CT chest with contrast | CPT 71260 | $1,281.31 |
| CT chest with and without contrast | CPT 71270 | $1,519.14 |
| MRI chest without contrast | CPT 71550 | $1,125.38 |
| MRI chest with contrast | CPT 71551 | $1,938.99 |
| MRI chest with and without contrast | CPT 71552 | $2,038.27 |
| Lumbosacral spine X-ray | CPT 72100 | $256.44 |
| CT cervical spine without contrast | CPT 72125 | $1,013.48 |
| CT thoracic spine without contrast | CPT 72128 | $1,013.48 |
| CT lumbar spine without contrast | CPT 72131 | $1,013.48 |
| MRI cervical spine without contrast | CPT 72141 | $1,526.17 |
| MRI thoracic spine without contrast | CPT 72146 | $1,532.37 |
| MRI lumbar spine without contrast | CPT 72148 | $1,517.28 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,715.51 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,972.75 |
| MRI lumbar spine with contrast | CPT 72158 | $1,944.25 |
| CT pelvis without contrast | CPT 72192 | $1,013.48 |
| CT pelvis with contrast | CPT 72193 | $1,281.31 |
| Shoulder X-ray | CPT 73030 | $487.14 |
| Humerus X-ray | CPT 73060 | $243.57 |
| Hand X-ray 3 views | CPT 73130 | $487.14 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,450.80 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,000.00 |
| Knee X-ray 1-2 views | CPT 73560 | $487.14 |
| Ankle X-ray 3 views | CPT 73610 | $487.14 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,689.44 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,654.13 |
| CT abdomen without contrast | CPT 74150 | $1,013.48 |
| CT abdomen with contrast | CPT 74160 | $1,281.31 |
| CT abdomen with and without contrast | CPT 74170 | $1,519.14 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,940.56 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,562.62 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,038.28 |
| MRI abdomen without contrast | CPT 74181 | $1,536.34 |
| MRI abdomen with and without contrast | CPT 74183 | $2,002.46 |
| Abdominal ultrasound complete | CPT 76700 | $542.60 |
| Abdominal ultrasound limited | CPT 76705 | $542.60 |
| Retroperitoneal ultrasound complete | CPT 76770 | $493.16 |
| Obstetric ultrasound first trimester | CPT 76801 | $542.60 |
| Obstetric ultrasound after first trimester | CPT 76805 | $542.60 |
| Transvaginal ultrasound | CPT 76830 | $542.60 |
| Pelvic ultrasound complete | CPT 76856 | $542.60 |
| Scrotal ultrasound | CPT 76870 | $542.60 |
| Diagnostic mammography unilateral | CPT 77065 | $432.31 |
| Diagnostic mammography bilateral | CPT 77066 | $497.12 |
| Screening mammography bilateral | CPT 77067 | $190.61 |
| EKG tracing only | CPT 93005 | $203.99 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,414.05 |
| Transthoracic echocardiogram | CPT 93307 | $518.70 |
| Stress echocardiogram | CPT 93350 | $1,364.70 |
| Basic metabolic panel (BMP) | CPT 80048 | $26.67 |
| General health panel | CPT 80050 | $403.35 |
| Electrolyte panel | CPT 80051 | $16.71 |
| Comprehensive metabolic panel | CPT 80053 | $38.41 |
| Lipid panel | CPT 80061 | $48.83 |
| Renal function panel | CPT 80069 | $31.57 |
| Hepatic function panel | CPT 80076 | $22.98 |
| Urinalysis non-automated | CPT 81002 | $8.39 |
| Urinalysis automated | CPT 81003 | $8.17 |
| Glucose quantitative | CPT 82947 | $12.42 |
| Hemoglobin A1c | CPT 83036 | $30.68 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $53.12 |
| Complete blood count with automated differential | CPT 85025 | $28.26 |
| Complete blood count without differential | CPT 85027 | $23.52 |
| Urine culture bacterial | CPT 87086 | $29.18 |
| Urine culture identification | CPT 87088 | $29.26 |
| Tissue exam by pathologist level IV | CPT 88305 | $129.62 |
| Fetal non-stress test | CPT 59025 | $466.82 |
| Office visit, new patient, 15-29 min | CPT 99202 | $87.71 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $119.74 |
| Office visit, new patient, 45-59 min | CPT 99204 | $145.50 |
| Office visit, new patient, 60-74 min | CPT 99205 | $162.90 |
| Office visit, established patient, 5 min | CPT 99211 | $57.78 |
| Office visit, established patient, 10-19 min | CPT 99212 | $68.92 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $87.02 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $109.30 |
| Office visit, established patient, 40-54 min | CPT 99215 | $135.05 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,276.92 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,641.20 |
| Sigmoidoscopy diagnostic | CPT 45330 | $2,627.87 |
| Sigmoidoscopy with biopsy | CPT 45331 | $3,255.67 |
| Colonoscopy diagnostic | CPT 45378 | $3,776.29 |
| Colonoscopy with biopsy | CPT 45380 | $4,213.40 |
| Colonoscopy with polyp removal | CPT 45385 | $4,066.19 |
| PCI single major coronary artery | CPT 92920 | $14,594 |
| PCI with drug-eluting stent | CPT 92928 | $39,697 |
| PCI bypass graft | CPT 92937 | $54,292 |
| Coronary angiography with cath | CPT 93455 | $12,269 |
| Coronary angiography with bypass cath | CPT 93458 | $15,815 |
