| Psychiatric diagnostic evaluation | CPT 90791 | $163.62 |
| Psychiatric eval with medical services | CPT 90792 | $97.36 |
| Psychotherapy 30 minutes | CPT 90832 | $112.31 |
| Psychotherapy 45 minutes | CPT 90834 | $207.25 |
| Psychotherapy 60 minutes | CPT 90837 | $271.08 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $63.25 |
| ED visit level 1 | CPT 99281 | $91.00 |
| ED visit level 2 | CPT 99282 | $160.75 |
| ED visit level 3 | CPT 99283 | $281.75 |
| ED visit level 4 | CPT 99284 | $433.25 |
| ED visit level 5 | CPT 99285 | $723.50 |
| Critical care, first hour | CPT 99291 | $1,642.25 |
| CT head without contrast | CPT 70450 | $798.25 |
| CT head with contrast | CPT 70460 | $907.75 |
| CT head with and without contrast | CPT 70470 | $1,046.50 |
| CT neck with contrast | CPT 70491 | $920.25 |
| MRI brain without contrast | CPT 70551 | $790.00 |
| MRI brain with contrast | CPT 70552 | $805.75 |
| MRI brain with and without contrast | CPT 70553 | $1,260.75 |
| Chest X-ray single view | CPT 71045 | $143.00 |
| Chest X-ray 2 views | CPT 71046 | $125.25 |
| Chest X-ray 3 views | CPT 71047 | $94.25 |
| CT chest without contrast | CPT 71250 | $899.00 |
| CT chest with contrast | CPT 71260 | $1,050.25 |
| CT chest with and without contrast | CPT 71270 | $1,281.75 |
| MRI chest without contrast | CPT 71550 | $817.50 |
| MRI chest with contrast | CPT 71551 | $938.00 |
| MRI chest with and without contrast | CPT 71552 | $1,331.00 |
| Lumbosacral spine X-ray | CPT 72100 | $90.00 |
| CT cervical spine without contrast | CPT 72125 | $922.00 |
| CT thoracic spine without contrast | CPT 72128 | $845.50 |
| CT lumbar spine without contrast | CPT 72131 | $943.75 |
| MRI cervical spine without contrast | CPT 72141 | $834.25 |
| MRI thoracic spine without contrast | CPT 72146 | $869.25 |
| MRI lumbar spine without contrast | CPT 72148 | $844.50 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,035.25 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,179.25 |
| MRI lumbar spine with contrast | CPT 72158 | $1,290.25 |
| CT pelvis without contrast | CPT 72192 | $895.25 |
| CT pelvis with contrast | CPT 72193 | $1,004.25 |
| Shoulder X-ray | CPT 73030 | $125.63 |
| Humerus X-ray | CPT 73060 | $135.00 |
| Hand X-ray 3 views | CPT 73130 | $139.13 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,157.25 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,042.75 |
| Knee X-ray 1-2 views | CPT 73560 | $118.88 |
| Ankle X-ray 3 views | CPT 73610 | $125.63 |
| MRI lower extremity joint without contrast | CPT 73721 | $807.00 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,116.00 |
| CT abdomen without contrast | CPT 74150 | $853.00 |
| CT abdomen with contrast | CPT 74160 | $1,059.00 |
| CT abdomen with and without contrast | CPT 74170 | $1,192.75 |
| CT abdomen and pelvis without contrast | CPT 74176 | $738.75 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,103.75 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,103.75 |
| MRI abdomen without contrast | CPT 74181 | $870.00 |
| MRI abdomen with and without contrast | CPT 74183 | $1,142.25 |
| Abdominal ultrasound complete | CPT 76700 | $543.50 |
| Abdominal ultrasound limited | CPT 76705 | $406.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $421.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $407.25 |
| Obstetric ultrasound after first trimester | CPT 76805 | $420.25 |
| Transvaginal ultrasound | CPT 76830 | $458.25 |
| Pelvic ultrasound complete | CPT 76856 | $443.00 |
| Scrotal ultrasound | CPT 76870 | $355.00 |
| Diagnostic mammography unilateral | CPT 77065 | $169.75 |
| Diagnostic mammography bilateral | CPT 77066 | $211.50 |
| Screening mammography bilateral | CPT 77067 | $187.00 |
| EKG tracing only | CPT 93005 | $149.50 |
| Transthoracic echocardiogram complete | CPT 93306 | $550.50 |
| Transthoracic echocardiogram | CPT 93307 | $482.50 |
| Stress echocardiogram | CPT 93350 | $670.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $90.75 |
| General health panel | CPT 80050 | $236.50 |
| Electrolyte panel | CPT 80051 | $89.75 |
| Comprehensive metabolic panel | CPT 80053 | $121.75 |
| Lipid panel | CPT 80061 | $91.75 |
| Renal function panel | CPT 80069 | $112.25 |
| Hepatic function panel | CPT 80076 | $95.50 |
| Urinalysis non-automated | CPT 81002 | $17.25 |
| Urinalysis automated | CPT 81003 | $27.00 |
| Glucose quantitative | CPT 82947 | $29.25 |
| Hemoglobin A1c | CPT 83036 | $44.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $61.50 |
| Complete blood count with automated differential | CPT 85025 | $49.50 |
| Complete blood count without differential | CPT 85027 | $45.50 |
| Urine culture bacterial | CPT 87086 | $53.00 |
| Tissue exam by pathologist level IV | CPT 88305 | $118.25 |
| Office visit, established patient, 5 min | CPT 99211 | $68.24 |
| Upper GI endoscopy diagnostic | CPT 43235 | $535.75 |
| Upper GI endoscopy with biopsy | CPT 43239 | $535.75 |
| Sigmoidoscopy diagnostic | CPT 45330 | $569.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | $354.00 |
| Colonoscopy diagnostic | CPT 45378 | $541.25 |
| Colonoscopy with biopsy | CPT 45380 | $541.25 |
| Colonoscopy with polyp removal | CPT 45385 | $541.25 |
