| Psychotherapy 60 minutes | CPT 90837 | $249.43 |
| ED visit level 1 | CPT 99281 | $374.01 |
| ED visit level 2 | CPT 99282 | $436.76 |
| ED visit level 3 | CPT 99283 | $732.84 |
| ED visit level 4 | CPT 99284 | $1,118.9 |
| ED visit level 5 | CPT 99285 | $1,820.57 |
| Critical care, first hour | CPT 99291 | $2,330 |
| CT head without contrast | CPT 70450 | $1,414.04 |
| CT head with contrast | CPT 70460 | $1,766.48 |
| CT head with and without contrast | CPT 70470 | $1,739.99 |
| CT neck with contrast | CPT 70491 | $2,032.5 |
| MRI brain without contrast | CPT 70551 | $2,874.36 |
| MRI brain with contrast | CPT 70552 | $3,745.1 |
| MRI brain with and without contrast | CPT 70553 | $4,007.67 |
| Chest X-ray single view | CPT 71045 | $325.1 |
| Chest X-ray 2 views | CPT 71046 | $600.28 |
| Chest X-ray 3 views | CPT 71047 | $586.56 |
| CT chest without contrast | CPT 71250 | $1,759.42 |
| CT chest with contrast | CPT 71260 | $2,045.9 |
| CT chest with and without contrast | CPT 71270 | $2,544.81 |
| MRI chest without contrast | CPT 71550 | $3,792.37 |
| MRI chest with contrast | CPT 71551 | $4,020.24 |
| MRI chest with and without contrast | CPT 71552 | $4,917.44 |
| Lumbosacral spine X-ray | CPT 72100 | $690.84 |
| CT cervical spine without contrast | CPT 72125 | $1,771.78 |
| CT thoracic spine without contrast | CPT 72128 | $1,766.48 |
| CT lumbar spine without contrast | CPT 72131 | $1,761.18 |
| MRI cervical spine without contrast | CPT 72141 | $2,973.39 |
| MRI thoracic spine without contrast | CPT 72146 | $2,976.9 |
| MRI lumbar spine without contrast | CPT 72148 | $2,971.63 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,705.18 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,963.66 |
| MRI lumbar spine with contrast | CPT 72158 | $3,954.23 |
| CT pelvis without contrast | CPT 72192 | $1,387.63 |
| CT pelvis with contrast | CPT 72193 | $2,096.13 |
| Shoulder X-ray | CPT 73030 | $487.65 |
| Humerus X-ray | CPT 73060 | $471.39 |
| Hand X-ray 3 views | CPT 73130 | $552.68 |
| MRI upper extremity joint without contrast | CPT 73221 | $3,192.98 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,949.52 |
| Knee X-ray 1-2 views | CPT 73560 | $503.91 |
| Ankle X-ray 3 views | CPT 73610 | $577.07 |
| MRI lower extremity joint without contrast | CPT 73721 | $3,279.44 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,949.52 |
| CT abdomen without contrast | CPT 74150 | $1,377.12 |
| CT abdomen with contrast | CPT 74160 | $2,089.42 |
| CT abdomen with and without contrast | CPT 74170 | $2,498.18 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,659.13 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,491.23 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,990.15 |
| MRI abdomen without contrast | CPT 74181 | $2,980.41 |
| MRI abdomen with and without contrast | CPT 74183 | $4,170.48 |
| Abdominal ultrasound complete | CPT 76700 | $998.26 |
| Abdominal ultrasound limited | CPT 76705 | $998.26 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,241.08 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,636.76 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,293.64 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $869 |
| Transvaginal ultrasound | CPT 76830 | $905.78 |
| Pelvic ultrasound complete | CPT 76856 | $988.04 |
| Scrotal ultrasound | CPT 76870 | $905.79 |
| EKG tracing only | CPT 93005 | $201.08 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,088.93 |
| Stress echocardiogram | CPT 93350 | $1,383.34 |
| Basic metabolic panel (BMP) | CPT 80048 | $144.34 |
| Electrolyte panel | CPT 80051 | $160.99 |
| Comprehensive metabolic panel | CPT 80053 | $226.97 |
| Lipid panel | CPT 80061 | $145.09 |
| Renal function panel | CPT 80069 | $868.3 |
| Hepatic function panel | CPT 80076 | $226.97 |
| Urinalysis non-automated | CPT 81002 | $54.82 |
| Urinalysis automated | CPT 81003 | $54.82 |
| Glucose quantitative | CPT 82947 | $213.31 |
| Hemoglobin A1c | CPT 83036 | $85.93 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $210.22 |
| Complete blood count with automated differential | CPT 85025 | $190.96 |
| Complete blood count without differential | CPT 85027 | $148.26 |
| Urine culture bacterial | CPT 87086 | $113.76 |
| Tissue exam by pathologist level IV | CPT 88305 | $403.61 |
| Fetal non-stress test | CPT 59025 | $511.8 |
| Vaginal delivery only | CPT 59409 | $5,612.29 |
| Office visit, new patient, 15-29 min | CPT 99202 | $298.21 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $448.98 |
| Office visit, new patient, 45-59 min | CPT 99204 | $585.34 |
| Office visit, new patient, 60-74 min | CPT 99205 | $698.39 |
| Office visit, established patient, 5 min | CPT 99211 | $75.37 |
| Office visit, established patient, 10-19 min | CPT 99212 | $174.04 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $287.12 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $430.12 |
| Office visit, established patient, 40-54 min | CPT 99215 | $542.08 |
| PCI bypass graft | CPT 92937 | $12,637 |
| Left heart catheterization | CPT 93452 | $5,407.96 |
| Coronary angiography with bypass cath | CPT 93458 | $6,744.22 |
