| Psychiatric diagnostic evaluation | CPT 90791 | $439.97 |
| Psychiatric eval with medical services | CPT 90792 | $408.32 |
| Psychotherapy 30 minutes | CPT 90832 | $186.43 |
| Psychotherapy 45 minutes | CPT 90834 | $334.4 |
| Psychotherapy 60 minutes | CPT 90837 | $304.52 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $304.52 |
| ED visit level 1 | CPT 99281 | $313.63 |
| ED visit level 2 | CPT 99282 | $533.81 |
| ED visit level 3 | CPT 99283 | $731.81 |
| ED visit level 4 | CPT 99284 | $957.53 |
| ED visit level 5 | CPT 99285 | $1,182.46 |
| Critical care, first hour | CPT 99291 | $1,769.33 |
| CT head without contrast | CPT 70450 | $1,154.74 |
| CT head with contrast | CPT 70460 | $1,467.58 |
| CT head with and without contrast | CPT 70470 | $1,840.61 |
| CT neck with contrast | CPT 70491 | $3,259.08 |
| MRI brain without contrast | CPT 70551 | $1,667.16 |
| MRI brain with contrast | CPT 70552 | $1,858.82 |
| MRI brain with and without contrast | CPT 70553 | $2,622.31 |
| Chest X-ray single view | CPT 71045 | $287.5 |
| Chest X-ray 2 views | CPT 71046 | $315.22 |
| Chest X-ray 3 views | CPT 71047 | $315.22 |
| CT chest without contrast | CPT 71250 | $1,787.54 |
| CT chest with contrast | CPT 71260 | $1,462.03 |
| CT chest with and without contrast | CPT 71270 | $2,988.22 |
| MRI chest without contrast | CPT 71550 | $617.76 |
| MRI chest with and without contrast | CPT 71552 | $1,212.64 |
| Lumbosacral spine X-ray | CPT 72100 | $373.03 |
| CT cervical spine without contrast | CPT 72125 | $1,098.5 |
| CT thoracic spine without contrast | CPT 72128 | $1,329.77 |
| CT lumbar spine without contrast | CPT 72131 | $1,138.1 |
| MRI cervical spine without contrast | CPT 72141 | $2,950.99 |
| MRI thoracic spine without contrast | CPT 72146 | $1,473.91 |
| MRI lumbar spine without contrast | CPT 72148 | $2,902.68 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,270.17 |
| MRI cervical spine with and without contrast | CPT 72156 | $5,530.54 |
| MRI lumbar spine with contrast | CPT 72158 | $4,728.24 |
| CT pelvis without contrast | CPT 72192 | $1,329.77 |
| CT pelvis with contrast | CPT 72193 | $1,907.14 |
| Shoulder X-ray | CPT 73030 | $384.91 |
| Humerus X-ray | CPT 73060 | $414.48 |
| Hand X-ray 3 views | CPT 73130 | $373.03 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,561.03 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,950.99 |
| Knee X-ray 1-2 views | CPT 73560 | $311.26 |
| Ankle X-ray 3 views | CPT 73610 | $427.68 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,707.06 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,525.19 |
| CT abdomen without contrast | CPT 74150 | $2,855.16 |
| CT abdomen with contrast | CPT 74160 | $3,490.34 |
| CT abdomen with and without contrast | CPT 74170 | $4,243.54 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,866.74 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,150.28 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,757.74 |
| MRI abdomen without contrast | CPT 74181 | $3,471.34 |
| MRI abdomen with and without contrast | CPT 74183 | $4,762.3 |
| Abdominal ultrasound complete | CPT 76700 | $907.63 |
| Abdominal ultrasound limited | CPT 76705 | $552.02 |
| Retroperitoneal ultrasound complete | CPT 76770 | $850.61 |
| Obstetric ultrasound first trimester | CPT 76801 | $388.87 |
| Obstetric ultrasound after first trimester | CPT 76805 | $388.87 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $654.19 |
| Transvaginal ultrasound | CPT 76830 | $850.61 |
| Pelvic ultrasound complete | CPT 76856 | $850.61 |
| Scrotal ultrasound | CPT 76870 | $1,174.54 |
| Diagnostic mammography unilateral | CPT 77065 | $293.92 |
| Diagnostic mammography bilateral | CPT 77066 | $556.78 |
| Screening mammography bilateral | CPT 77067 | $224.26 |
| EKG tracing only | CPT 93005 | $330.22 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,540.75 |
| Transthoracic echocardiogram | CPT 93307 | $887.04 |
| Basic metabolic panel (BMP) | CPT 80048 | $152.64 |
| Electrolyte panel | CPT 80051 | $86.33 |
| Comprehensive metabolic panel | CPT 80053 | $226.4 |
| Lipid panel | CPT 80061 | $163.15 |
| Renal function panel | CPT 80069 | $145.73 |
| Hepatic function panel | CPT 80076 | $167.9 |
| Urinalysis automated | CPT 81003 | $25.52 |
| Glucose quantitative | CPT 82947 | $49.1 |
| Hemoglobin A1c | CPT 83036 | $113.26 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $171.07 |
| Complete blood count with automated differential | CPT 85025 | $114.84 |
| Complete blood count without differential | CPT 85027 | $72.86 |
| Urine culture bacterial | CPT 87086 | $125.93 |
| Tissue exam by pathologist level IV | CPT 88305 | $449.16 |
| Vaginal delivery only | CPT 59409 | $5,646.17 |
| Office visit, new patient, 15-29 min | CPT 99202 | $416.33 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $479.03 |
| Office visit, new patient, 45-59 min | CPT 99204 | $372.24 |
| Office visit, new patient, 60-74 min | CPT 99205 | $563.2 |
| Office visit, established patient, 5 min | CPT 99211 | $416.33 |
| Office visit, established patient, 10-19 min | CPT 99212 | $73.92 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $146.08 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $225.28 |
| Office visit, established patient, 40-54 min | CPT 99215 | $319.44 |
