| Psychotherapy 30 minutes | CPT 90832 | $210.50 |
| Psychotherapy 45 minutes | CPT 90834 | $279.00 |
| Psychotherapy 60 minutes | CPT 90837 | $420.50 |
| ED visit level 1 | CPT 99281 | $341.50 |
| ED visit level 2 | CPT 99282 | $382.00 |
| ED visit level 3 | CPT 99283 | $565.00 |
| ED visit level 4 | CPT 99284 | $902.50 |
| ED visit level 5 | CPT 99285 | $1,448.00 |
| Critical care, first hour | CPT 99291 | $1,735.00 |
| CT head without contrast | CPT 70450 | $2,317.00 |
| CT head with contrast | CPT 70460 | $3,081.50 |
| CT head with and without contrast | CPT 70470 | $3,463.00 |
| CT neck with contrast | CPT 70491 | $3,763.00 |
| MRI brain without contrast | CPT 70551 | $5,044.50 |
| MRI brain with contrast | CPT 70552 | $5,556.50 |
| MRI brain with and without contrast | CPT 70553 | $7,029.00 |
| Chest X-ray single view | CPT 71045 | $404.50 |
| Chest X-ray 2 views | CPT 71046 | $530.50 |
| Chest X-ray 3 views | CPT 71047 | $688.50 |
| CT chest without contrast | CPT 71250 | $2,945.00 |
| CT chest with contrast | CPT 71260 | $3,248.00 |
| CT chest with and without contrast | CPT 71270 | $4,086.00 |
| MRI chest without contrast | CPT 71550 | $5,600.50 |
| MRI chest with and without contrast | CPT 71552 | $8,255.50 |
| Lumbosacral spine X-ray | CPT 72100 | $796.50 |
| CT cervical spine without contrast | CPT 72125 | $2,726.00 |
| CT thoracic spine without contrast | CPT 72128 | $2,726.00 |
| CT lumbar spine without contrast | CPT 72131 | $3,503.00 |
| MRI cervical spine without contrast | CPT 72141 | $4,511.50 |
| MRI thoracic spine without contrast | CPT 72146 | $4,548.50 |
| MRI lumbar spine without contrast | CPT 72148 | $4,544.50 |
| MRI lumbar spine with and without contrast | CPT 72149 | $5,047.00 |
| MRI cervical spine with and without contrast | CPT 72156 | $6,972.50 |
| MRI lumbar spine with contrast | CPT 72158 | $6,965.00 |
| CT pelvis without contrast | CPT 72192 | $3,170.50 |
| CT pelvis with contrast | CPT 72193 | $3,962.50 |
| Shoulder X-ray | CPT 73030 | $570.50 |
| Humerus X-ray | CPT 73060 | $565.00 |
| Hand X-ray 3 views | CPT 73130 | $1,295.00 |
| MRI upper extremity joint without contrast | CPT 73221 | $6,657.00 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $9,353.50 |
| Knee X-ray 1-2 views | CPT 73560 | $1,164.50 |
| Ankle X-ray 3 views | CPT 73610 | $658.00 |
| MRI lower extremity joint without contrast | CPT 73721 | $4,872.50 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $6,755.00 |
| CT abdomen without contrast | CPT 74150 | $3,160.50 |
| CT abdomen with contrast | CPT 74160 | $3,534.50 |
| CT abdomen with and without contrast | CPT 74170 | $4,845.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,962.50 |
| CT abdomen and pelvis with contrast | CPT 74177 | $4,283.50 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $591.50 |
| MRI abdomen without contrast | CPT 74181 | $4,483.50 |
| MRI abdomen with and without contrast | CPT 74183 | $9,335.50 |
| Abdominal ultrasound complete | CPT 76700 | $1,269.50 |
| Abdominal ultrasound limited | CPT 76705 | $982.50 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,223.50 |
| Obstetric ultrasound first trimester | CPT 76801 | $2,236.50 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,406.50 |
| Transvaginal ultrasound | CPT 76830 | $1,149.50 |
| Pelvic ultrasound complete | CPT 76856 | $1,144.50 |
| Scrotal ultrasound | CPT 76870 | $1,157.50 |
| Diagnostic mammography unilateral | CPT 77065 | $712.00 |
| Diagnostic mammography bilateral | CPT 77066 | $712.00 |
| Screening mammography bilateral | CPT 77067 | $712.00 |
| EKG complete | CPT 93000 | $441.50 |
| EKG tracing only | CPT 93005 | $385.50 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,052.50 |
| Basic metabolic panel (BMP) | CPT 80048 | $166.50 |
| General health panel | CPT 80050 | $602.50 |
| Electrolyte panel | CPT 80051 | $138.50 |
| Comprehensive metabolic panel | CPT 80053 | $196.00 |
| Lipid panel | CPT 80061 | $184.00 |
| Renal function panel | CPT 80069 | $138.50 |
| Hepatic function panel | CPT 80076 | $156.50 |
| Urinalysis non-automated | CPT 81002 | $25.50 |
| Urinalysis automated | CPT 81003 | $48.50 |
| Glucose quantitative | CPT 82947 | $71.00 |
| Hemoglobin A1c | CPT 83036 | $191.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $270.50 |
| Complete blood count with automated differential | CPT 85025 | $136.50 |
| Complete blood count without differential | CPT 85027 | $111.50 |
| Urine culture bacterial | CPT 87086 | $90.00 |
| Urine culture identification | CPT 87088 | $74.50 |
| Tissue exam by pathologist level IV | CPT 88305 | $1,016.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $269.50 |
| Office visit, new patient, 45-59 min | CPT 99204 | $413.50 |
| Office visit, new patient, 60-74 min | CPT 99205 | $509.50 |
| Office visit, established patient, 5 min | CPT 99211 | $85.50 |
| Upper GI endoscopy diagnostic | CPT 43235 | $778.50 |
| Upper GI endoscopy with biopsy | CPT 43239 | $915.00 |
| Sigmoidoscopy diagnostic | CPT 45330 | $903.50 |
| Colonoscopy diagnostic | CPT 45378 | $1,231.50 |
| Colonoscopy with biopsy | CPT 45380 | $1,391.00 |
| Colonoscopy with polyp removal | CPT 45385 | $1,638.50 |
| Shoulder arthroscopy with decompression | CPT 29826 | $3,625.50 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $1,956.00 |
| Laparoscopic cholecystectomy | CPT 47562 | $4,172.50 |
| Cataract surgery with lens implant | CPT 66984 | $4,556.50 |
