| Psychiatric diagnostic evaluation | CPT 90791 | $167.9 |
| Psychiatric eval with medical services | CPT 90792 | $333.84 |
| Psychotherapy 30 minutes | CPT 90832 | $55.38 |
| Psychotherapy 45 minutes | CPT 90834 | $113.06 |
| Psychotherapy 60 minutes | CPT 90837 | $141.52 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $292.23 |
| EKG tracing only | CPT 93005 | $284.93 |
| Hospital discharge, <30 min | CPT 99238 | $71.54 |
| Basic metabolic panel (BMP) | CPT 80048 | $467.63 |
| Electrolyte panel | CPT 80051 | $432.1 |
| Comprehensive metabolic panel | CPT 80053 | $577.83 |
| Lipid panel | CPT 80061 | $390.78 |
| Renal function panel | CPT 80069 | $577.83 |
| Hepatic function panel | CPT 80076 | $477.05 |
| Urinalysis non-automated | CPT 81002 | $35.5 |
| Urinalysis automated | CPT 81003 | $45.68 |
| Glucose quantitative | CPT 82947 | $269.7 |
| Hemoglobin A1c | CPT 83036 | $4 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $183.43 |
| Complete blood count with automated differential | CPT 85025 | $270.43 |
| Complete blood count without differential | CPT 85027 | $288.55 |
| Urine culture bacterial | CPT 87086 | $162.4 |
| Urine culture identification | CPT 87088 | $126.15 |
| Tissue exam by pathologist level IV | CPT 88305 | $153.49 |
| Fetal non-stress test | CPT 59025 | $275.18 |
| Vaginal delivery only | CPT 59409 | $3,506.1 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $77.38 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,081.3 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,081.3 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,060.48 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,060.48 |
| Colonoscopy diagnostic | CPT 45378 | $1,060.48 |
| Colonoscopy with biopsy | CPT 45380 | $1,385.74 |
| Colonoscopy with polyp removal | CPT 45385 | $1,385.74 |
| Total shoulder arthroplasty | CPT 23472 | $16,478 |
| Total hip replacement | CPT 27130 | $16,478 |
| Total knee replacement | CPT 27447 | $16,478 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $8,370.28 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,784.43 |
| ACL reconstruction | CPT 29888 | $8,370.28 |
| Open appendectomy | CPT 44950 | $4,251.64 |
| Laparoscopic appendectomy | CPT 44970 | $6,761.72 |
| Laparoscopic cholecystectomy | CPT 47562 | $6,761.72 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $6,761.72 |
| Open umbilical hernia repair | CPT 49560 | $4,251.64 |
| Umbilical hernia repair age 5+ | CPT 49585 | $4,251.64 |
| Lap inguinal hernia repair | CPT 49650 | $6,761.72 |
| Lap incisional hernia repair | CPT 49652 | $6,761.72 |
| Vaginal hysterectomy | CPT 58260 | $5,892.64 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $6,761.72 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $11,902 |
| Lap salpingo-oophorectomy | CPT 58661 | $6,761.72 |
| Complex cataract surgery | CPT 66982 | $2,775.06 |
| Cataract surgery with lens implant | CPT 66984 | $2,775.06 |
| Intravitreal injection | CPT 67028 | $426.09 |
| Vitrectomy mechanical | CPT 67042 | $5,233.3 |
