| Psychiatric diagnostic evaluation | CPT 90791 | $155.5 |
| Psychiatric eval with medical services | CPT 90792 | $172.5 |
| Psychotherapy 30 minutes | CPT 90832 | $76 |
| Psychotherapy 45 minutes | CPT 90834 | $101 |
| Psychotherapy 60 minutes | CPT 90837 | $150.5 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $158 |
| ED visit level 4 | CPT 99284 | $773 |
| ED visit level 5 | CPT 99285 | $1,127 |
| Critical care, first hour | CPT 99291 | $1,587.5 |
| CT head without contrast | CPT 70450 | $701.5 |
| CT head with contrast | CPT 70460 | $891.5 |
| CT head with and without contrast | CPT 70470 | $1,003 |
| CT neck with contrast | CPT 70491 | $913 |
| MRI brain without contrast | CPT 70551 | $1,283 |
| MRI brain with contrast | CPT 70552 | $1,308.5 |
| MRI brain with and without contrast | CPT 70553 | $2,232.5 |
| Chest X-ray single view | CPT 71045 | $153.5 |
| Chest X-ray 2 views | CPT 71046 | $174.5 |
| Chest X-ray 3 views | CPT 71047 | $133.5 |
| CT chest without contrast | CPT 71250 | $824.5 |
| CT chest with contrast | CPT 71260 | $956 |
| CT chest with and without contrast | CPT 71270 | $1,064 |
| Lumbosacral spine X-ray | CPT 72100 | $277.5 |
| CT cervical spine without contrast | CPT 72125 | $828 |
| CT thoracic spine without contrast | CPT 72128 | $720 |
| CT lumbar spine without contrast | CPT 72131 | $720 |
| MRI cervical spine without contrast | CPT 72141 | $1,283 |
| MRI thoracic spine without contrast | CPT 72146 | $1,263 |
| MRI lumbar spine without contrast | CPT 72148 | $1,283 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,326 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,229.5 |
| MRI lumbar spine with contrast | CPT 72158 | $2,232.5 |
| CT pelvis without contrast | CPT 72192 | $639.5 |
| CT pelvis with contrast | CPT 72193 | $905.5 |
| Shoulder X-ray | CPT 73030 | $153.5 |
| Humerus X-ray | CPT 73060 | $133.5 |
| Hand X-ray 3 views | CPT 73130 | $277.5 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,283 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,332 |
| Knee X-ray 1-2 views | CPT 73560 | $156 |
| Ankle X-ray 3 views | CPT 73610 | $133.5 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,283 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,486.5 |
| CT abdomen without contrast | CPT 74150 | $733 |
| CT abdomen with contrast | CPT 74160 | $980 |
| CT abdomen with and without contrast | CPT 74170 | $1,106 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,142 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,224 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,117.5 |
| MRI abdomen without contrast | CPT 74181 | $1,283 |
| MRI abdomen with and without contrast | CPT 74183 | $1,486.5 |
| Abdominal ultrasound complete | CPT 76700 | $242 |
| Abdominal ultrasound limited | CPT 76705 | $277.5 |
| Retroperitoneal ultrasound complete | CPT 76770 | $242 |
| Obstetric ultrasound first trimester | CPT 76801 | $132.5 |
| Obstetric ultrasound after first trimester | CPT 76805 | $198 |
| Transvaginal ultrasound | CPT 76830 | $188.5 |
| Pelvic ultrasound complete | CPT 76856 | $242 |
| Scrotal ultrasound | CPT 76870 | $242 |
| Diagnostic mammography unilateral | CPT 77065 | $96 |
| Diagnostic mammography bilateral | CPT 77066 | $101 |
| Screening mammography bilateral | CPT 77067 | $81 |
| EKG complete | CPT 93000 | $36.5 |
| EKG tracing only | CPT 93005 | $160 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,227 |
| Initial hospital care, low complexity | CPT 99221 | $47.5 |
| Initial hospital care, moderate complexity | CPT 99222 | $75 |
| Initial hospital care, high complexity | CPT 99223 | $95 |
| Basic metabolic panel (BMP) | CPT 80048 | $122 |
| Electrolyte panel | CPT 80051 | $88.5 |
| Comprehensive metabolic panel | CPT 80053 | $197.5 |
| Lipid panel | CPT 80061 | $79 |
| Renal function panel | CPT 80069 | $106 |
| Hepatic function panel | CPT 80076 | $120 |
| Urinalysis automated | CPT 81003 | $6.5 |
| Glucose quantitative | CPT 82947 | $10.5 |
| Hemoglobin A1c | CPT 83036 | $27.5 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $91.5 |
| Complete blood count with automated differential | CPT 85025 | $29.5 |
| Complete blood count without differential | CPT 85027 | $38 |
| Urine culture bacterial | CPT 87086 | $71.5 |
| Tissue exam by pathologist level IV | CPT 88305 | $123 |
| Vaginal delivery only | CPT 59409 | $3,986 |
| Office visit, new patient, 15-29 min | CPT 99202 | $107.5 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $171.5 |
| Office visit, new patient, 45-59 min | CPT 99204 | $259.5 |
| Office visit, new patient, 60-74 min | CPT 99205 | $347 |
| Office visit, established patient, 5 min | CPT 99211 | $66.5 |
| Office visit, established patient, 10-19 min | CPT 99212 | $57 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $93 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $130.5 |
| Office visit, established patient, 40-54 min | CPT 99215 | $183 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,717 |
| Colonoscopy diagnostic | CPT 45378 | $2,717 |
| Laparoscopic cholecystectomy | CPT 47562 | $7,543.5 |
| Lap inguinal hernia repair | CPT 49650 | $1,706.5 |
| Cataract surgery with lens implant | CPT 66984 | $2,850.5 |
