| Psychotherapy 30 minutes | CPT 90832 | $405.00 |
| Psychotherapy 45 minutes | CPT 90834 | $537.50 |
| Psychotherapy 60 minutes | CPT 90837 | $648.50 |
| ED visit level 1 | CPT 99281 | $231.50 |
| ED visit level 2 | CPT 99282 | $393.00 |
| CT head without contrast | CPT 70450 | $1,550.50 |
| CT head with contrast | CPT 70460 | $1,742.50 |
| CT head with and without contrast | CPT 70470 | $3,310.50 |
| CT neck with contrast | CPT 70491 | $2,178.50 |
| Chest X-ray single view | CPT 71045 | $261.00 |
| Chest X-ray 2 views | CPT 71046 | $352.00 |
| Chest X-ray 3 views | CPT 71047 | $361.00 |
| CT chest without contrast | CPT 71250 | $1,568.50 |
| CT chest with contrast | CPT 71260 | $1,742.50 |
| CT chest with and without contrast | CPT 71270 | $2,787.50 |
| Lumbosacral spine X-ray | CPT 72100 | $348.50 |
| CT cervical spine without contrast | CPT 72125 | $2,156.00 |
| CT thoracic spine without contrast | CPT 72128 | $2,003.50 |
| CT lumbar spine without contrast | CPT 72131 | $1,829.50 |
| CT pelvis without contrast | CPT 72192 | $1,916.50 |
| CT pelvis with contrast | CPT 72193 | $1,742.50 |
| Shoulder X-ray | CPT 73030 | $466.50 |
| Humerus X-ray | CPT 73060 | $317.50 |
| Hand X-ray 3 views | CPT 73130 | $343.00 |
| Knee X-ray 1-2 views | CPT 73560 | $301.00 |
| Ankle X-ray 3 views | CPT 73610 | $339.50 |
| CT abdomen without contrast | CPT 74150 | $1,568.50 |
| CT abdomen with contrast | CPT 74160 | $1,742.50 |
| CT abdomen with and without contrast | CPT 74170 | $1,848.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,640.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,168.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,696.00 |
| Abdominal ultrasound complete | CPT 76700 | $683.50 |
| Abdominal ultrasound limited | CPT 76705 | $753.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $753.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $889.50 |
| Obstetric ultrasound after first trimester | CPT 76805 | $623.00 |
| Transvaginal ultrasound | CPT 76830 | $707.00 |
| Pelvic ultrasound complete | CPT 76856 | $801.00 |
| Scrotal ultrasound | CPT 76870 | $588.50 |
| EKG tracing only | CPT 93005 | $169.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,623.00 |
| Initial hospital care, low complexity | CPT 99221 | $346.00 |
| Initial hospital care, moderate complexity | CPT 99222 | $466.50 |
| Initial hospital care, high complexity | CPT 99223 | $604.50 |
| Hospital discharge, <30 min | CPT 99238 | $244.50 |
| Hospital discharge, >30 min | CPT 99239 | $277.50 |
| Basic metabolic panel (BMP) | CPT 80048 | $155.50 |
| General health panel | CPT 80050 | $397.00 |
| Electrolyte panel | CPT 80051 | $57.50 |
| Comprehensive metabolic panel | CPT 80053 | $176.00 |
| Lipid panel | CPT 80061 | $220.00 |
| Renal function panel | CPT 80069 | $179.00 |
| Hepatic function panel | CPT 80076 | $128.50 |
| Urinalysis non-automated | CPT 81002 | $21.50 |
| Urinalysis automated | CPT 81003 | $47.50 |
| Glucose quantitative | CPT 82947 | $33.50 |
| Hemoglobin A1c | CPT 83036 | $149.50 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $170.00 |
| Complete blood count with automated differential | CPT 85025 | $68.00 |
| Urine culture bacterial | CPT 87086 | $107.50 |
| Urine culture identification | CPT 87088 | $137.00 |
| Tissue exam by pathologist level IV | CPT 88305 | $505.50 |
| Vaginal delivery only | CPT 59409 | $1,490.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $124.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $186.50 |
| Office visit, new patient, 45-59 min | CPT 99204 | $278.00 |
| Office visit, new patient, 60-74 min | CPT 99205 | $367.00 |
| Office visit, established patient, 5 min | CPT 99211 | $98.50 |
| Office visit, established patient, 10-19 min | CPT 99212 | $97.00 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $124.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $176.00 |
| Office visit, established patient, 40-54 min | CPT 99215 | $240.50 |
