| Psychiatric diagnostic evaluation | CPT 90791 | $217.38 |
| Psychiatric eval with medical services | CPT 90792 | $438.01 |
| Psychotherapy 30 minutes | CPT 90832 | $94.09 |
| Psychotherapy 45 minutes | CPT 90834 | $217.38 |
| Psychotherapy 60 minutes | CPT 90837 | $94.09 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $94.09 |
| ED visit level 1 | CPT 99281 | $101.64 |
| ED visit level 2 | CPT 99282 | $198.66 |
| ED visit level 3 | CPT 99283 | $270 |
| ED visit level 4 | CPT 99284 | $470.32 |
| ED visit level 5 | CPT 99285 | $559.14 |
| Critical care, first hour | CPT 99291 | $616.46 |
| CT head without contrast | CPT 70450 | $634.22 |
| CT head with contrast | CPT 70460 | $673.36 |
| CT head with and without contrast | CPT 70470 | $845.74 |
| CT neck with contrast | CPT 70491 | $735.79 |
| MRI brain without contrast | CPT 70551 | $1,034.89 |
| MRI brain with contrast | CPT 70552 | $1,284.6 |
| MRI brain with and without contrast | CPT 70553 | $1,739.3 |
| Chest X-ray single view | CPT 71045 | $109.47 |
| Chest X-ray 2 views | CPT 71046 | $109.47 |
| Chest X-ray 3 views | CPT 71047 | $113.05 |
| CT chest without contrast | CPT 71250 | $1,473.65 |
| CT chest with contrast | CPT 71260 | $715.6 |
| CT chest with and without contrast | CPT 71270 | $801.94 |
| MRI chest without contrast | CPT 71550 | $1,029.92 |
| MRI chest with contrast | CPT 71551 | $1,207.57 |
| MRI chest with and without contrast | CPT 71552 | $1,605.44 |
| Lumbosacral spine X-ray | CPT 72100 | $134.67 |
| CT cervical spine without contrast | CPT 72125 | $741.69 |
| CT thoracic spine without contrast | CPT 72128 | $701.93 |
| CT lumbar spine without contrast | CPT 72131 | $741.69 |
| MRI cervical spine without contrast | CPT 72141 | $1,155.08 |
| MRI thoracic spine without contrast | CPT 72146 | $1,059.42 |
| MRI lumbar spine without contrast | CPT 72148 | $1,168.13 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,279.63 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,375.6 |
| MRI lumbar spine with contrast | CPT 72158 | $1,739.3 |
| CT pelvis without contrast | CPT 72192 | $548.81 |
| CT pelvis with contrast | CPT 72193 | $606.89 |
| Shoulder X-ray | CPT 73030 | $269.29 |
| Humerus X-ray | CPT 73060 | $182.34 |
| Hand X-ray 3 views | CPT 73130 | $109.47 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,039.86 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,521.58 |
| Knee X-ray 1-2 views | CPT 73560 | $181.69 |
| Ankle X-ray 3 views | CPT 73610 | $109.47 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,114.09 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,423.6 |
| CT abdomen without contrast | CPT 74150 | $613.73 |
| CT abdomen with contrast | CPT 74160 | $701.93 |
| CT abdomen with and without contrast | CPT 74170 | $1,437.41 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,266.59 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,362.25 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,229.42 |
| MRI abdomen without contrast | CPT 74181 | $1,029.92 |
| MRI abdomen with and without contrast | CPT 74183 | $1,652.65 |
| Abdominal ultrasound complete | CPT 76700 | $220.21 |
| Abdominal ultrasound limited | CPT 76705 | $420.49 |
| Retroperitoneal ultrasound complete | CPT 76770 | $216.79 |
| Obstetric ultrasound first trimester | CPT 76801 | $231.7 |
| Obstetric ultrasound after first trimester | CPT 76805 | $168.34 |
| Transvaginal ultrasound | CPT 76830 | $213.38 |
| Pelvic ultrasound complete | CPT 76856 | $183.87 |
| Scrotal ultrasound | CPT 76870 | $183.87 |
| EKG tracing only | CPT 93005 | $202.46 |
| EKG interpretation only | CPT 93010 | $24.01 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,356.2 |
| Transthoracic echocardiogram | CPT 93307 | $893.54 |
| Initial hospital care, low complexity | CPT 99221 | $191.43 |
| Initial hospital care, moderate complexity | CPT 99222 | $260.21 |
| Initial hospital care, high complexity | CPT 99223 | $356.25 |
| Hospital discharge, <30 min | CPT 99238 | $101.88 |
| Hospital discharge, >30 min | CPT 99239 | $139.51 |
| Basic metabolic panel (BMP) | CPT 80048 | $43.17 |
| General health panel | CPT 80050 | $349.86 |
| Electrolyte panel | CPT 80051 | $27.02 |
| Comprehensive metabolic panel | CPT 80053 | $77.96 |
| Lipid panel | CPT 80061 | $60.57 |
| Renal function panel | CPT 80069 | $44.73 |
| Hepatic function panel | CPT 80076 | $41.93 |
| Glucose quantitative | CPT 82947 | $48.02 |
| Hemoglobin A1c | CPT 83036 | $54.66 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $76.09 |
| Complete blood count with automated differential | CPT 85025 | $30.13 |
| Urine culture bacterial | CPT 87086 | $21.01 |
| Vaginal delivery only | CPT 59409 | $2,125.15 |
| Office visit, new patient, 15-29 min | CPT 99202 | $238.15 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $313.42 |
| Office visit, new patient, 45-59 min | CPT 99204 | $313.42 |
| Office visit, new patient, 60-74 min | CPT 99205 | $377.66 |
| Office visit, established patient, 5 min | CPT 99211 | $183.64 |
| Office visit, established patient, 10-19 min | CPT 99212 | $120.7 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $158.98 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $280.32 |
| Office visit, established patient, 40-54 min | CPT 99215 | $277.08 |
| Upper GI endoscopy diagnostic | CPT 43235 | $671.61 |
| Upper GI endoscopy with biopsy | CPT 43239 | $864.33 |
| Sigmoidoscopy diagnostic | CPT 45330 | $445.63 |
| Sigmoidoscopy with biopsy | CPT 45331 | $799.16 |
| Colonoscopy diagnostic | CPT 45378 | $957.82 |
| Colonoscopy with biopsy | CPT 45380 | $944.92 |
| Colonoscopy with polyp removal | CPT 45385 | $1,018.77 |
