| Psychiatric diagnostic evaluation | CPT 90791 | $290 |
| Psychotherapy 30 minutes | CPT 90832 | $145 |
| Psychotherapy 45 minutes | CPT 90834 | $221.85 |
| Psychotherapy 60 minutes | CPT 90837 | $263.9 |
| ED visit level 1 | CPT 99281 | $72 |
| ED visit level 2 | CPT 99282 | $139.69 |
| ED visit level 3 | CPT 99283 | $245.03 |
| ED visit level 4 | CPT 99284 | $236.8 |
| ED visit level 5 | CPT 99285 | $344 |
| Critical care, first hour | CPT 99291 | $767.72 |
| CT head without contrast | CPT 70450 | $400 |
| CT head with contrast | CPT 70460 | $400 |
| CT head with and without contrast | CPT 70470 | $400 |
| CT neck with contrast | CPT 70491 | $400 |
| MRI brain without contrast | CPT 70551 | $800 |
| MRI brain with contrast | CPT 70552 | $800 |
| MRI brain with and without contrast | CPT 70553 | $800 |
| Chest X-ray single view | CPT 71045 | $86.88 |
| Chest X-ray 2 views | CPT 71046 | $18.2 |
| CT chest without contrast | CPT 71250 | $532.38 |
| CT chest with contrast | CPT 71260 | $400 |
| MRI chest without contrast | CPT 71550 | $520 |
| MRI chest with and without contrast | CPT 71552 | $800 |
| Lumbosacral spine X-ray | CPT 72100 | $106.88 |
| CT cervical spine without contrast | CPT 72125 | $400 |
| CT thoracic spine without contrast | CPT 72128 | $400 |
| CT lumbar spine without contrast | CPT 72131 | $400 |
| MRI cervical spine without contrast | CPT 72141 | $800 |
| MRI thoracic spine without contrast | CPT 72146 | $800 |
| MRI lumbar spine without contrast | CPT 72148 | $800 |
| MRI cervical spine with and without contrast | CPT 72156 | $800 |
| MRI lumbar spine with contrast | CPT 72158 | $800 |
| CT pelvis without contrast | CPT 72192 | $400 |
| CT pelvis with contrast | CPT 72193 | $400 |
| Shoulder X-ray | CPT 73030 | $98.8 |
| Humerus X-ray | CPT 73060 | $90.8 |
| Hand X-ray 3 views | CPT 73130 | $86.88 |
| MRI upper extremity joint without contrast | CPT 73221 | $800 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $800 |
| Knee X-ray 1-2 views | CPT 73560 | $86.88 |
| Ankle X-ray 3 views | CPT 73610 | $96.6 |
| MRI lower extremity joint without contrast | CPT 73721 | $800 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $800 |
| CT abdomen without contrast | CPT 74150 | $400 |
| CT abdomen with contrast | CPT 74160 | $400 |
| CT abdomen with and without contrast | CPT 74170 | $400 |
| CT abdomen and pelvis without contrast | CPT 74176 | $400 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,813.79 |
| MRI abdomen without contrast | CPT 74181 | $460 |
| MRI abdomen with and without contrast | CPT 74183 | $800 |
| Abdominal ultrasound complete | CPT 76700 | $259.13 |
| Abdominal ultrasound limited | CPT 76705 | $184 |
| Retroperitoneal ultrasound complete | CPT 76770 | $186.2 |
| Obstetric ultrasound first trimester | CPT 76801 | $149.2 |
| Pelvic ultrasound complete | CPT 76856 | $220.2 |
| Scrotal ultrasound | CPT 76870 | $222.36 |
| EKG complete | CPT 93000 | $41.8 |
| EKG tracing only | CPT 93005 | $57.48 |
| EKG interpretation only | CPT 93010 | $9.08 |
| Transthoracic echocardiogram complete | CPT 93306 | $535.99 |
| Transthoracic echocardiogram | CPT 93307 | $73.5 |
| Initial hospital care, low complexity | CPT 99221 | $96.47 |
| Initial hospital care, moderate complexity | CPT 99222 | $130.46 |
| Initial hospital care, high complexity | CPT 99223 | $191.66 |
| Hospital discharge, <30 min | CPT 99238 | $69.58 |
| Hospital discharge, >30 min | CPT 99239 | $101.89 |
| Basic metabolic panel (BMP) | CPT 80048 | $33.84 |
| General health panel | CPT 80050 | $389.32 |
| Electrolyte panel | CPT 80051 | $90.85 |
| Comprehensive metabolic panel | CPT 80053 | $42.24 |
| Lipid panel | CPT 80061 | $53.56 |
| Renal function panel | CPT 80069 | $34.72 |
| Hepatic function panel | CPT 80076 | $32.68 |
| Urinalysis non-automated | CPT 81002 | $6.8 |
| Glucose quantitative | CPT 82947 | $15.72 |
| Hemoglobin A1c | CPT 83036 | $33.6 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $65.5 |
| Complete blood count with automated differential | CPT 85025 | $31.08 |
| Urine culture bacterial | CPT 87086 | $32.28 |
| Urine culture identification | CPT 87088 | $32.36 |
| Tissue exam by pathologist level IV | CPT 88305 | $469.37 |
| Vaginal delivery only | CPT 59409 | $2,827.44 |
| Office visit, new patient, 15-29 min | CPT 99202 | $47.55 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $80.95 |
| Office visit, new patient, 45-59 min | CPT 99204 | $131.51 |
| Office visit, new patient, 60-74 min | CPT 99205 | $178.48 |
| Office visit, established patient, 5 min | CPT 99211 | $32.5 |
| Office visit, established patient, 10-19 min | CPT 99212 | $103.75 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $65.19 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $95.97 |
| Office visit, established patient, 40-54 min | CPT 99215 | $142.12 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,877.4 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,988 |
| Sigmoidoscopy diagnostic | CPT 45330 | $831.04 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,779.83 |
| Colonoscopy diagnostic | CPT 45378 | $2,295.38 |
| Colonoscopy with biopsy | CPT 45380 | $2,405.9 |
| Colonoscopy with polyp removal | CPT 45385 | $2,454.2 |
