| Psychotherapy 45 minutes | CPT 90834 | $139.88 |
| Psychotherapy 60 minutes | CPT 90837 | $139.88 |
| ED visit level 1 | CPT 99281 | $87.82 |
| ED visit level 2 | CPT 99282 | $295.98 |
| ED visit level 3 | CPT 99283 | $238.05 |
| ED visit level 4 | CPT 99284 | $539.12 |
| ED visit level 5 | CPT 99285 | $519.31 |
| Critical care, first hour | CPT 99291 | $720.31 |
| CT head without contrast | CPT 70450 | $190.88 |
| CT head with contrast | CPT 70460 | $418.31 |
| CT head with and without contrast | CPT 70470 | $673.64 |
| CT neck with contrast | CPT 70491 | $418.51 |
| MRI brain without contrast | CPT 70551 | $401.6 |
| MRI brain with contrast | CPT 70552 | $431.69 |
| MRI brain with and without contrast | CPT 70553 | $524.73 |
| Chest X-ray single view | CPT 71045 | $45.8 |
| Chest X-ray 2 views | CPT 71046 | $234.45 |
| Chest X-ray 3 views | CPT 71047 | $75.89 |
| CT chest without contrast | CPT 71250 | $190.19 |
| CT chest with contrast | CPT 71260 | $607.24 |
| CT chest with and without contrast | CPT 71270 | $658.09 |
| MRI chest without contrast | CPT 71550 | $418.76 |
| MRI chest with contrast | CPT 71551 | $683.59 |
| MRI chest with and without contrast | CPT 71552 | $533.47 |
| Lumbosacral spine X-ray | CPT 72100 | $130.75 |
| CT cervical spine without contrast | CPT 72125 | $190.19 |
| CT thoracic spine without contrast | CPT 72128 | $326.38 |
| CT lumbar spine without contrast | CPT 72131 | $190.19 |
| MRI cervical spine without contrast | CPT 72141 | $389.9 |
| MRI thoracic spine without contrast | CPT 72146 | $418.76 |
| MRI lumbar spine without contrast | CPT 72148 | $604.35 |
| MRI lumbar spine with and without contrast | CPT 72149 | $450.33 |
| MRI cervical spine with and without contrast | CPT 72156 | $524.73 |
| MRI lumbar spine with contrast | CPT 72158 | $524.73 |
| CT pelvis without contrast | CPT 72192 | $326.38 |
| CT pelvis with contrast | CPT 72193 | $418.51 |
| Shoulder X-ray | CPT 73030 | $45.8 |
| Humerus X-ray | CPT 73060 | $45.8 |
| Hand X-ray 3 views | CPT 73130 | $186.38 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,225.61 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $436.96 |
| Knee X-ray 1-2 views | CPT 73560 | $75.89 |
| Ankle X-ray 3 views | CPT 73610 | $75.89 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,189.91 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $436.96 |
| CT abdomen without contrast | CPT 74150 | $326.38 |
| CT abdomen with contrast | CPT 74160 | $418.51 |
| CT abdomen with and without contrast | CPT 74170 | $619.9 |
| CT abdomen and pelvis without contrast | CPT 74176 | $674.82 |
| CT abdomen and pelvis with contrast | CPT 74177 | $821.88 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,461.78 |
| MRI abdomen without contrast | CPT 74181 | $1,496.25 |
| MRI abdomen with and without contrast | CPT 74183 | $609.27 |
| Abdominal ultrasound complete | CPT 76700 | $216.34 |
| Abdominal ultrasound limited | CPT 76705 | $283.14 |
| Retroperitoneal ultrasound complete | CPT 76770 | $92.78 |
| Obstetric ultrasound first trimester | CPT 76801 | $92.91 |
| Obstetric ultrasound after first trimester | CPT 76805 | $91.17 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $208.07 |
| Transvaginal ultrasound | CPT 76830 | $117.1 |
| Pelvic ultrasound complete | CPT 76856 | $91.17 |
| Scrotal ultrasound | CPT 76870 | $127.95 |
| Diagnostic mammography unilateral | CPT 77065 | $45.92 |
| Diagnostic mammography bilateral | CPT 77066 | $89.04 |
| Screening mammography bilateral | CPT 77067 | $109.42 |
| EKG tracing only | CPT 93005 | $46.23 |
| EKG interpretation only | CPT 93010 | $18.28 |
| Transthoracic echocardiogram complete | CPT 93306 | $335.13 |
| Initial hospital care, low complexity | CPT 99221 | $88.64 |
| Initial hospital care, moderate complexity | CPT 99222 | $119.04 |
| Initial hospital care, high complexity | CPT 99223 | $174.72 |
| Hospital discharge, <30 min | CPT 99238 | $63 |
| Hospital discharge, >30 min | CPT 99239 | $91.94 |
| Basic metabolic panel (BMP) | CPT 80048 | $176.69 |
| Electrolyte panel | CPT 80051 | $11.77 |
| Comprehensive metabolic panel | CPT 80053 | $41.98 |
| Lipid panel | CPT 80061 | $30.06 |
| Hepatic function panel | CPT 80076 | $26.79 |
| Urinalysis non-automated | CPT 81002 | $58.13 |
| Urinalysis automated | CPT 81003 | $3.78 |
| Hemoglobin A1c | CPT 83036 | $10.96 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $75.87 |
| Complete blood count with automated differential | CPT 85025 | $12.85 |
| Complete blood count without differential | CPT 85027 | $7.31 |
| Urine culture bacterial | CPT 87086 | $9.45 |
| Tissue exam by pathologist level IV | CPT 88305 | $119.31 |
| Fetal non-stress test | CPT 59025 | $176.3 |
| Vaginal delivery only | CPT 59409 | $2,683.41 |
| Office visit, new patient, 15-29 min | CPT 99202 | $246.21 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $369.32 |
| Office visit, new patient, 45-59 min | CPT 99204 | $553.98 |
| Office visit, new patient, 60-74 min | CPT 99205 | $738.63 |
| Office visit, established patient, 5 min | CPT 99211 | $61.55 |
| Office visit, established patient, 10-19 min | CPT 99212 | $123.11 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $149.15 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $307.76 |
| Office visit, established patient, 40-54 min | CPT 99215 | $492.42 |
| Upper GI endoscopy diagnostic | CPT 43235 | $790.92 |
| Upper GI endoscopy with biopsy | CPT 43239 | $790.92 |
| Colonoscopy diagnostic | CPT 45378 | $810.95 |
| Colonoscopy with biopsy | CPT 45380 | $1,036 |
| Colonoscopy with polyp removal | CPT 45385 | $1,036 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $1,700 |
| ACL reconstruction | CPT 29888 | $2,725 |
| Laparoscopic appendectomy | CPT 44970 | $2,725 |
| Laparoscopic cholecystectomy | CPT 47562 | $2,725 |
| Open umbilical hernia repair | CPT 49560 | $236.23 |
| Umbilical hernia repair age 5+ | CPT 49585 | $1,182.6 |
| Cataract surgery with lens implant | CPT 66984 | $1,925.83 |
