| Psychiatric diagnostic evaluation | CPT 90791 | $151.82 |
| Psychotherapy 30 minutes | CPT 90832 | $65.72 |
| Psychotherapy 45 minutes | CPT 90834 | $86.67 |
| Psychotherapy 60 minutes | CPT 90837 | $127.72 |
| ED visit level 1 | CPT 99281 | $312.62 |
| ED visit level 2 | CPT 99282 | $498.82 |
| ED visit level 3 | CPT 99283 | $87.25 |
| ED visit level 4 | CPT 99284 | $130.3 |
| ED visit level 5 | CPT 99285 | $195.45 |
| Critical care, first hour | CPT 99291 | $2,810.64 |
| CT head without contrast | CPT 70450 | $2,119.74 |
| CT head with and without contrast | CPT 70470 | $3,200.68 |
| CT neck with contrast | CPT 70491 | $2,872.38 |
| MRI brain without contrast | CPT 70551 | $3,665.2 |
| MRI brain with and without contrast | CPT 70553 | $4,934.3 |
| Chest X-ray single view | CPT 71045 | $398.86 |
| Chest X-ray 2 views | CPT 71046 | $419.44 |
| CT chest without contrast | CPT 71250 | $2,272.62 |
| CT chest with contrast | CPT 71260 | $3,047.8 |
| Lumbosacral spine X-ray | CPT 72100 | $442.96 |
| CT cervical spine without contrast | CPT 72125 | $2,272.62 |
| CT thoracic spine without contrast | CPT 72128 | $2,272.62 |
| CT lumbar spine without contrast | CPT 72131 | $2,222.64 |
| MRI cervical spine without contrast | CPT 72141 | $3,731.84 |
| MRI thoracic spine without contrast | CPT 72146 | $3,731.84 |
| MRI lumbar spine without contrast | CPT 72148 | $3,731.84 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,901.96 |
| MRI lumbar spine with contrast | CPT 72158 | $5,035.24 |
| CT pelvis without contrast | CPT 72192 | $2,057.02 |
| CT pelvis with contrast | CPT 72193 | $2,521.54 |
| Shoulder X-ray | CPT 73030 | $390.04 |
| Humerus X-ray | CPT 73060 | $334.18 |
| Hand X-ray 3 views | CPT 73130 | $342.02 |
| MRI upper extremity joint without contrast | CPT 73221 | $4,099.34 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,878.44 |
| Knee X-ray 1-2 views | CPT 73560 | $307.72 |
| Ankle X-ray 3 views | CPT 73610 | $318.5 |
| MRI lower extremity joint without contrast | CPT 73721 | $3,618.16 |
| CT abdomen without contrast | CPT 74150 | $2,211.86 |
| CT abdomen with contrast | CPT 74160 | $3,474.1 |
| CT abdomen with and without contrast | CPT 74170 | $3,896.48 |
| CT abdomen and pelvis without contrast | CPT 74176 | $4,074.84 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,361.58 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,188.12 |
| MRI abdomen without contrast | CPT 74181 | $4,087.58 |
| MRI abdomen with and without contrast | CPT 74183 | $4,971.54 |
| Abdominal ultrasound complete | CPT 76700 | $1,317.12 |
| Abdominal ultrasound limited | CPT 76705 | $1,004.5 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,004.5 |
| Obstetric ultrasound first trimester | CPT 76801 | $565.46 |
| Obstetric ultrasound after first trimester | CPT 76805 | $557.62 |
| Transvaginal ultrasound | CPT 76830 | $661.5 |
| Pelvic ultrasound complete | CPT 76856 | $1,175.02 |
| Scrotal ultrasound | CPT 76870 | $1,124.06 |
| Screening mammography bilateral | CPT 77067 | $552.72 |
| EKG complete | CPT 93000 | $14.64 |
| EKG tracing only | CPT 93005 | $275.38 |
| EKG interpretation only | CPT 93010 | $7.18 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,740.08 |
| Basic metabolic panel (BMP) | CPT 80048 | $166.84 |
| General health panel | CPT 80050 | $284.21 |
| Electrolyte panel | CPT 80051 | $116.4 |
| Comprehensive metabolic panel | CPT 80053 | $186.24 |
| Lipid panel | CPT 80061 | $125.13 |
| Renal function panel | CPT 80069 | $161.99 |
| Hepatic function panel | CPT 80076 | $161.99 |
| Urinalysis automated | CPT 81003 | $13.49 |
| Glucose quantitative | CPT 82947 | $69.58 |
| Hemoglobin A1c | CPT 83036 | $39.77 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $127.4 |
| Complete blood count with automated differential | CPT 85025 | $125.13 |
| Complete blood count without differential | CPT 85027 | $98.94 |
| Urine culture identification | CPT 87088 | $74.69 |
| Tissue exam by pathologist level IV | CPT 88305 | $221.48 |
| Office visit, new patient, 15-29 min | CPT 99202 | $61.99 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $94.71 |
| Office visit, new patient, 45-59 min | CPT 99204 | $141.2 |
| Office visit, new patient, 60-74 min | CPT 99205 | $186.84 |
| Office visit, established patient, 5 min | CPT 99211 | $20.09 |
| Office visit, established patient, 10-19 min | CPT 99212 | $48.22 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $77.2 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $109.35 |
| Office visit, established patient, 40-54 min | CPT 99215 | $153.55 |
