| Psychiatric diagnostic evaluation | CPT 90791 | $166.53 |
| Psychiatric eval with medical services | CPT 90792 | $187.30 |
| Psychotherapy 30 minutes | CPT 90832 | $75.71 |
| Psychotherapy 45 minutes | CPT 90834 | $99.88 |
| Psychotherapy 60 minutes | CPT 90837 | $147.25 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $141.72 |
| ED visit level 1 | CPT 99281 | $10.92 |
| ED visit level 2 | CPT 99282 | $39.84 |
| ED visit level 3 | CPT 99283 | $67.81 |
| ED visit level 4 | CPT 99284 | $115.38 |
| ED visit level 5 | CPT 99285 | $167.13 |
| Critical care, first hour | CPT 99291 | $3,349.97 |
| CT head without contrast | CPT 70450 | $104.16 |
| CT head with contrast | CPT 70460 | $145.68 |
| CT head with and without contrast | CPT 70470 | $170.56 |
| CT neck with contrast | CPT 70491 | $181.12 |
| MRI brain without contrast | CPT 70551 | $193.26 |
| MRI brain with contrast | CPT 70552 | $266.29 |
| MRI brain with and without contrast | CPT 70553 | $313.64 |
| Chest X-ray single view | CPT 71045 | $24.58 |
| Chest X-ray 2 views | CPT 71046 | $32.24 |
| Chest X-ray 3 views | CPT 71047 | $40.54 |
| CT chest without contrast | CPT 71250 | $130.69 |
| CT chest with contrast | CPT 71260 | $164.14 |
| CT chest with and without contrast | CPT 71270 | $192.84 |
| MRI chest without contrast | CPT 71550 | $292.86 |
| MRI chest with contrast | CPT 71551 | $367.80 |
| MRI chest with and without contrast | CPT 71552 | $458.13 |
| Lumbosacral spine X-ray | CPT 72100 | $38.29 |
| CT cervical spine without contrast | CPT 72125 | $127.79 |
| CT thoracic spine without contrast | CPT 72128 | $2,674.35 |
| CT lumbar spine without contrast | CPT 72131 | $126.84 |
| MRI cervical spine without contrast | CPT 72141 | $187.85 |
| MRI thoracic spine without contrast | CPT 72146 | $4,728.83 |
| MRI lumbar spine without contrast | CPT 72148 | $188.48 |
| MRI lumbar spine with and without contrast | CPT 72149 | $266.59 |
| MRI cervical spine with and without contrast | CPT 72156 | $315.23 |
| MRI lumbar spine with contrast | CPT 72158 | $314.59 |
| CT pelvis without contrast | CPT 72192 | $130.69 |
| CT pelvis with contrast | CPT 72193 | $222.71 |
| Shoulder X-ray | CPT 73030 | $33.50 |
| Humerus X-ray | CPT 73060 | $30.62 |
| Hand X-ray 3 views | CPT 73130 | $35.72 |
| MRI upper extremity joint without contrast | CPT 73221 | $4,728.83 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $381.38 |
| Knee X-ray 1-2 views | CPT 73560 | $32.85 |
| Ankle X-ray 3 views | CPT 73610 | $35.08 |
| MRI lower extremity joint without contrast | CPT 73721 | $199.57 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $4,728.83 |
| CT abdomen without contrast | CPT 74150 | $134.25 |
| CT abdomen with contrast | CPT 74160 | $227.85 |
| CT abdomen with and without contrast | CPT 74170 | $4,602.60 |
| CT abdomen and pelvis without contrast | CPT 74176 | $180.02 |
| CT abdomen and pelvis with contrast | CPT 74177 | $6,198.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $334.52 |
| MRI abdomen without contrast | CPT 74181 | $4,728.83 |
| MRI abdomen with and without contrast | CPT 74183 | $4,728.83 |
| Abdominal ultrasound complete | CPT 76700 | $111.46 |
| Abdominal ultrasound limited | CPT 76705 | $734.14 |
| Retroperitoneal ultrasound complete | CPT 76770 | $103.79 |
| Obstetric ultrasound first trimester | CPT 76801 | $112.52 |
| Obstetric ultrasound after first trimester | CPT 76805 | $130.02 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $170.28 |
| Transvaginal ultrasound | CPT 76830 | $496.65 |
| Pelvic ultrasound complete | CPT 76856 | $100.91 |
| Scrotal ultrasound | CPT 76870 | $95.80 |
| Diagnostic mammography unilateral | CPT 77065 | $120.06 |
| Diagnostic mammography bilateral | CPT 77066 | $151.97 |
| Screening mammography bilateral | CPT 77067 | $1,221.59 |
| EKG complete | CPT 93000 | $13.75 |
| EKG tracing only | CPT 93005 | $261.79 |
| EKG interpretation only | CPT 93010 | $7.72 |
| Transthoracic echocardiogram complete | CPT 93306 | $188.18 |
| Transthoracic echocardiogram | CPT 93307 | $130.62 |
| Stress echocardiogram | CPT 93350 | $177.69 |
| Initial hospital care, low complexity | CPT 99221 | $78.95 |
| Initial hospital care, moderate complexity | CPT 99222 | $124.61 |
| Initial hospital care, high complexity | CPT 99223 | $165.17 |
| Hospital discharge, <30 min | CPT 99238 | $77.38 |
| Hospital discharge, >30 min | CPT 99239 | $109.20 |
| Basic metabolic panel (BMP) | CPT 80048 | $336.94 |
| General health panel | CPT 80050 | $16.32 |
| Electrolyte panel | CPT 80051 | $6.87 |
| Comprehensive metabolic panel | CPT 80053 | $439.46 |
| Lipid panel | CPT 80061 | $13.12 |
| Renal function panel | CPT 80069 | $8.51 |
| Hepatic function panel | CPT 80076 | $8.01 |
| Urinalysis non-automated | CPT 81002 | $3.41 |
| Urinalysis automated | CPT 81003 | $58.84 |
| Glucose quantitative | CPT 82947 | $3.85 |
| Hemoglobin A1c | CPT 83036 | $110.40 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $164.85 |
| Complete blood count with automated differential | CPT 85025 | $7.61 |
| Complete blood count without differential | CPT 85027 | $6.34 |
| Urine culture bacterial | CPT 87086 | $7.91 |
| Urine culture identification | CPT 87088 | $7.93 |
| Tissue exam by pathologist level IV | CPT 88305 | $97.57 |
| Fetal non-stress test | CPT 59025 | $47.21 |
| Vaginal delivery only | CPT 59409 | $766.74 |
| Vaginal delivery with postpartum | CPT 59410 | $1,038.01 |
| C-section delivery only | CPT 59514 | $766.74 |
| C-section with postpartum | CPT 59515 | $1,038.01 |
| Office visit, new patient, 15-29 min | CPT 99202 | $69.47 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $107.29 |
| Office visit, new patient, 45-59 min | CPT 99204 | $160.89 |
| Office visit, new patient, 60-74 min | CPT 99205 | $212.19 |
| Office visit, established patient, 5 min | CPT 99211 | $22.36 |
| Office visit, established patient, 10-19 min | CPT 99212 | $54.41 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $87.47 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $123.41 |
| Office visit, established patient, 40-54 min | CPT 99215 | $173.75 |
| Upper GI endoscopy diagnostic | CPT 43235 | $275.50 |
| Upper GI endoscopy with biopsy | CPT 43239 | $359.96 |
| Sigmoidoscopy diagnostic | CPT 45330 | $178.23 |
| Sigmoidoscopy with biopsy | CPT 45331 | $273.54 |
| Colonoscopy diagnostic | CPT 45378 | $325.58 |
| Colonoscopy with biopsy | CPT 45380 | $414.84 |
| Colonoscopy with polyp removal | CPT 45385 | $434.64 |
| Total shoulder arthroplasty | CPT 23472 | $1,388.52 |
| Hip hemiarthroplasty | CPT 27125 | $1,090.82 |
| Total hip replacement | CPT 27130 | $1,234.83 |
| Total knee replacement | CPT 27447 | $1,232.94 |
| Knee revision arthroplasty single component | CPT 27486 | $1,350.47 |
| Knee revision arthroplasty all components | CPT 27487 | $1,681.81 |
| Shoulder arthroscopy with decompression | CPT 29826 | $163.18 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,031.19 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $527.14 |
| ACL reconstruction | CPT 29888 | $940.50 |
| CABG single arterial graft | CPT 33533 | $1,760.89 |
| CABG 2 arterial grafts | CPT 33534 | $2,067.80 |
| CABG 3 arterial grafts | CPT 33535 | $2,297.54 |
| CABG 4+ arterial grafts | CPT 33536 | $2,475.69 |
| Open appendectomy | CPT 44950 | $617.18 |
| Laparoscopic appendectomy | CPT 44970 | $580.64 |
| Laparoscopic cholecystectomy | CPT 47562 | $636.18 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $691.45 |
| Lap inguinal hernia repair | CPT 49650 | $418.89 |
| Total abdominal hysterectomy | CPT 58150 | $980.14 |
| Vaginal hysterectomy | CPT 58260 | $810.14 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $851.48 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $945.65 |
| Lap salpingo-oophorectomy | CPT 58661 | $629.05 |
| Complex cataract surgery | CPT 66982 | $708.32 |
| Cataract surgery with lens implant | CPT 66984 | $517.03 |
| Intravitreal injection | CPT 67028 | $107.91 |
| Vitrectomy mechanical | CPT 67042 | $1,083.40 |
| PCI single major coronary artery | CPT 92920 | $494.11 |
| PCI with drug-eluting stent | CPT 92928 | $549.76 |
| PCI bypass graft | CPT 92937 | $549.74 |
| Left heart catheterization | CPT 93452 | $845.42 |
| Coronary angiography with cath | CPT 93455 | $950.03 |
| Coronary angiography with bypass cath | CPT 93458 | $980.68 |
