| Psychiatric diagnostic evaluation | CPT 90791 | $249.75 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $109 |
| ED visit level 1 | CPT 99281 | $38.09 |
| ED visit level 2 | CPT 99282 | $68.51 |
| ED visit level 3 | CPT 99283 | $78.36 |
| ED visit level 5 | CPT 99285 | $609.22 |
| Critical care, first hour | CPT 99291 | $476.53 |
| CT head with contrast | CPT 70460 | $1,179.71 |
| MRI brain without contrast | CPT 70551 | $772.33 |
| MRI brain with and without contrast | CPT 70553 | $539.47 |
| Chest X-ray single view | CPT 71045 | $133.15 |
| CT chest without contrast | CPT 71250 | $569.91 |
| CT chest with contrast | CPT 71260 | $1,018.94 |
| MRI chest with and without contrast | CPT 71552 | $1,272.07 |
| CT thoracic spine without contrast | CPT 72128 | $1,426.82 |
| CT lumbar spine without contrast | CPT 72131 | $592.48 |
| MRI cervical spine without contrast | CPT 72141 | $528.96 |
| MRI thoracic spine without contrast | CPT 72146 | $692.25 |
| MRI lumbar spine without contrast | CPT 72148 | $615.9 |
| MRI cervical spine with and without contrast | CPT 72156 | $541.28 |
| MRI lumbar spine with contrast | CPT 72158 | $1,066.8 |
| CT pelvis without contrast | CPT 72192 | $696.32 |
| CT pelvis with contrast | CPT 72193 | $1,636.74 |
| Shoulder X-ray | CPT 73030 | $121.63 |
| Humerus X-ray | CPT 73060 | $92.84 |
| Hand X-ray 3 views | CPT 73130 | $149.32 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,002.85 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $536.75 |
| Knee X-ray 1-2 views | CPT 73560 | $270.07 |
| Ankle X-ray 3 views | CPT 73610 | $163.62 |
| CT abdomen with and without contrast | CPT 74170 | $1,795.12 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,706.58 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,473.47 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,716.36 |
| MRI abdomen with and without contrast | CPT 74183 | $751.58 |
| Abdominal ultrasound complete | CPT 76700 | $392.42 |
| Abdominal ultrasound limited | CPT 76705 | $409.15 |
| Retroperitoneal ultrasound complete | CPT 76770 | $299.28 |
| Obstetric ultrasound after first trimester | CPT 76805 | $489.12 |
| Pelvic ultrasound complete | CPT 76856 | $226.23 |
| Diagnostic mammography unilateral | CPT 77065 | $135.29 |
| Diagnostic mammography bilateral | CPT 77066 | $113.98 |
| Screening mammography bilateral | CPT 77067 | $231.28 |
| EKG interpretation only | CPT 93010 | $9.41 |
| Initial hospital care, low complexity | CPT 99221 | $81.29 |
| Initial hospital care, high complexity | CPT 99223 | $132.69 |
| Hospital discharge, <30 min | CPT 99238 | $58.15 |
| Comprehensive metabolic panel | CPT 80053 | $95.5 |
| Lipid panel | CPT 80061 | $74.45 |
| Renal function panel | CPT 80069 | $159.94 |
| Hepatic function panel | CPT 80076 | $113.51 |
| Urinalysis automated | CPT 81003 | $18.9 |
| Glucose quantitative | CPT 82947 | $113 |
| Hemoglobin A1c | CPT 83036 | $32.02 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $77 |
| Complete blood count without differential | CPT 85027 | $53.6 |
| Urine culture bacterial | CPT 87086 | $73.01 |
| Fetal non-stress test | CPT 59025 | $294.06 |
| Vaginal delivery only | CPT 59409 | $1,406 |
| Office visit, established patient, 5 min | CPT 99211 | $115.7 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $58.68 |
| Office visit, established patient, 40-54 min | CPT 99215 | $148.76 |
| Upper GI endoscopy diagnostic | CPT 43235 | $497.16 |
| Upper GI endoscopy with biopsy | CPT 43239 | $809.44 |
| Sigmoidoscopy with biopsy | CPT 45331 | $448 |
| Colonoscopy diagnostic | CPT 45378 | $1,276.34 |
| Colonoscopy with biopsy | CPT 45380 | $1,421.27 |
| Colonoscopy with polyp removal | CPT 45385 | $1,601.99 |
| Total shoulder arthroplasty | CPT 23472 | $1,194.09 |
| Total hip replacement | CPT 27130 | $828.58 |
| Total knee replacement | CPT 27447 | $1,052.29 |
| Knee revision arthroplasty single component | CPT 27486 | $2,564.17 |
| Knee revision arthroplasty all components | CPT 27487 | $255.11 |
| Shoulder arthroscopy with decompression | CPT 29826 | $110.37 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $3,222.42 |
| ACL reconstruction | CPT 29888 | $1,940.35 |
