| Psychiatric diagnostic evaluation | CPT 90791 | $195.66 |
| Psychotherapy 30 minutes | CPT 90832 | $152.77 |
| Psychotherapy 45 minutes | CPT 90834 | $195.66 |
| Psychotherapy 60 minutes | CPT 90837 | $325.46 |
| ED visit level 1 | CPT 99281 | $44.28 |
| ED visit level 2 | CPT 99282 | $86.35 |
| ED visit level 3 | CPT 99283 | $128.42 |
| ED visit level 4 | CPT 99284 | $252.4 |
| ED visit level 5 | CPT 99285 | $380.81 |
| Critical care, first hour | CPT 99291 | $3,089.84 |
| CT head without contrast | CPT 70450 | $761.97 |
| CT head with contrast | CPT 70460 | $996.75 |
| CT head with and without contrast | CPT 70470 | $1,224.41 |
| CT neck with contrast | CPT 70491 | $1,235.08 |
| MRI brain without contrast | CPT 70551 | $1,582.28 |
| MRI brain with contrast | CPT 70552 | $2,095.94 |
| MRI brain with and without contrast | CPT 70553 | $2,384.79 |
| Chest X-ray single view | CPT 71045 | $77.55 |
| Chest X-ray 2 views | CPT 71046 | $106.01 |
| Chest X-ray 3 views | CPT 71047 | $133.76 |
| CT chest without contrast | CPT 71250 | $986.08 |
| CT chest with contrast | CPT 71260 | $1,240.07 |
| CT chest with and without contrast | CPT 71270 | $1,548.83 |
| MRI chest without contrast | CPT 71550 | $2,066.77 |
| MRI chest with contrast | CPT 71551 | $2,330.01 |
| MRI chest with and without contrast | CPT 71552 | $2,855.06 |
| Lumbosacral spine X-ray | CPT 72100 | $171.96 |
| CT cervical spine without contrast | CPT 72125 | $998.17 |
| CT thoracic spine without contrast | CPT 72128 | $996.75 |
| CT lumbar spine without contrast | CPT 72131 | $991.06 |
| MRI cervical spine without contrast | CPT 72141 | $1,346.85 |
| MRI thoracic spine without contrast | CPT 72146 | $1,350.54 |
| MRI lumbar spine without contrast | CPT 72148 | $1,345.38 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,073.88 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,935.04 |
| MRI lumbar spine with contrast | CPT 72158 | $1,926.18 |
| CT pelvis without contrast | CPT 72192 | $924.89 |
| CT pelvis with contrast | CPT 72193 | $1,174.61 |
| Shoulder X-ray | CPT 73030 | $212.55 |
| Humerus X-ray | CPT 73060 | $117.35 |
| Hand X-ray 3 views | CPT 73130 | $137.27 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,853.12 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,401.46 |
| Knee X-ray 1-2 views | CPT 73560 | $126.94 |
| Ankle X-ray 3 views | CPT 73610 | $143.91 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,903.31 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,401.46 |
| CT abdomen without contrast | CPT 74150 | $922.05 |
| CT abdomen with contrast | CPT 74160 | $1,370.26 |
| CT abdomen with and without contrast | CPT 74170 | $1,903.14 |
| CT abdomen and pelvis without contrast | CPT 74176 | $835.25 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,595.08 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,106.61 |
| MRI abdomen without contrast | CPT 74181 | $1,791.87 |
| MRI abdomen with and without contrast | CPT 74183 | $2,741.67 |
| Abdominal ultrasound complete | CPT 76700 | $532.88 |
| Abdominal ultrasound limited | CPT 76705 | $414.07 |
| Retroperitoneal ultrasound complete | CPT 76770 | $163.76 |
| Obstetric ultrasound first trimester | CPT 76801 | $414.07 |
| Obstetric ultrasound after first trimester | CPT 76805 | $525.77 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $464.59 |
| Transvaginal ultrasound | CPT 76830 | $486.64 |
| Pelvic ultrasound complete | CPT 76856 | $500.37 |
| Scrotal ultrasound | CPT 76870 | $488.06 |
| Diagnostic mammography unilateral | CPT 77065 | $259.04 |
| Diagnostic mammography bilateral | CPT 77066 | $259.04 |
| Screening mammography bilateral | CPT 77067 | $203.69 |
| EKG tracing only | CPT 93005 | $289.72 |
| EKG interpretation only | CPT 93010 | $24.2 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,446.48 |
| Transthoracic echocardiogram | CPT 93307 | $1,156.11 |
| Initial hospital care, low complexity | CPT 99221 | $197.08 |
| Initial hospital care, moderate complexity | CPT 99222 | $268.22 |
| Initial hospital care, high complexity | CPT 99223 | $394.15 |
| Hospital discharge, <30 min | CPT 99238 | $130.91 |
| Hospital discharge, >30 min | CPT 99239 | $199.93 |
| Basic metabolic panel (BMP) | CPT 80048 | $6.91 |
| Electrolyte panel | CPT 80051 | $92.49 |
| Comprehensive metabolic panel | CPT 80053 | $13.18 |
| Lipid panel | CPT 80061 | $10.4 |
| Renal function panel | CPT 80069 | $132.34 |
| Hepatic function panel | CPT 80076 | $6.67 |
| Urinalysis non-automated | CPT 81002 | $9.26 |
| Urinalysis automated | CPT 81003 | $51.77 |
| Glucose quantitative | CPT 82947 | $22.74 |
| Hemoglobin A1c | CPT 83036 | $36.9 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $135.18 |
| Complete blood count with automated differential | CPT 85025 | $96.05 |
| Complete blood count without differential | CPT 85027 | $54.59 |
| Urine culture bacterial | CPT 87086 | $5.61 |
| Urine culture identification | CPT 87088 | $6.09 |
| Tissue exam by pathologist level IV | CPT 88305 | $40.25 |
| Office visit, new patient, 15-29 min | CPT 99202 | $100.88 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $149.13 |
| Office visit, new patient, 45-59 min | CPT 99204 | $195.3 |
| Office visit, new patient, 60-74 min | CPT 99205 | $246.14 |
| Office visit, established patient, 5 min | CPT 99211 | $15.18 |
| Office visit, established patient, 10-19 min | CPT 99212 | $23 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $37.49 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $55.2 |
| Office visit, established patient, 40-54 min | CPT 99215 | $74.29 |
| Upper GI endoscopy diagnostic | CPT 43235 | $632.48 |
| Upper GI endoscopy with biopsy | CPT 43239 | $729.95 |
| Sigmoidoscopy diagnostic | CPT 45330 | $128.07 |
| Sigmoidoscopy with biopsy | CPT 45331 | $155.1 |
| Colonoscopy diagnostic | CPT 45378 | $438.26 |
| Colonoscopy with biopsy | CPT 45380 | $525.77 |
| Colonoscopy with polyp removal | CPT 45385 | $622.53 |
| Total shoulder arthroplasty | CPT 23472 | $2,774.15 |
| Hip hemiarthroplasty | CPT 27125 | $3,197.98 |
| Total hip replacement | CPT 27130 | $2,568.34 |
| Total knee replacement | CPT 27447 | $2,742.65 |
| Knee revision arthroplasty single component | CPT 27486 | $2,602.93 |
| Knee revision arthroplasty all components | CPT 27487 | $3,133.94 |
| Shoulder arthroscopy with decompression | CPT 29826 | $340.23 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,917.37 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $971.85 |
| ACL reconstruction | CPT 29888 | $1,765.12 |
| Open appendectomy | CPT 44950 | $1,161.1 |
| Laparoscopic appendectomy | CPT 44970 | $1,084.97 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,181.01 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $1,280.61 |
| Open umbilical hernia repair | CPT 49560 | $1,336.11 |
| Umbilical hernia repair age 5+ | CPT 49585 | $796.83 |
| Lap inguinal hernia repair | CPT 49650 | $768.37 |
| Lap incisional hernia repair | CPT 49652 | $1,347.49 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,165.36 |
