| Psychiatric diagnostic evaluation | CPT 90791 | $428.56 |
| Psychiatric eval with medical services | CPT 90792 | $441.65 |
| Psychotherapy 30 minutes | CPT 90832 | $46.86 |
| Psychotherapy 45 minutes | CPT 90834 | $121.17 |
| Psychotherapy 60 minutes | CPT 90837 | $178.88 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $88.36 |
| ED visit level 1 | CPT 99281 | $318.32 |
| ED visit level 2 | CPT 99282 | $575.32 |
| ED visit level 3 | CPT 99283 | $974.25 |
| ED visit level 4 | CPT 99284 | $1,557.83 |
| ED visit level 5 | CPT 99285 | $1,976.74 |
| Critical care, first hour | CPT 99291 | $230.40 |
| CT head without contrast | CPT 70450 | $97.85 |
| CT head with contrast | CPT 70460 | $136.72 |
| CT head with and without contrast | CPT 70470 | $160.07 |
| CT neck with contrast | CPT 70491 | $124.93 |
| MRI brain without contrast | CPT 70551 | $181.44 |
| MRI brain with contrast | CPT 70552 | $249.12 |
| MRI brain with and without contrast | CPT 70553 | $288.59 |
| Chest X-ray single view | CPT 71045 | $33.24 |
| Chest X-ray 2 views | CPT 71046 | $42.89 |
| Chest X-ray 3 views | CPT 71047 | $53.81 |
| CT chest without contrast | CPT 71250 | $990.65 |
| CT chest with contrast | CPT 71260 | $1,193.85 |
| CT chest with and without contrast | CPT 71270 | $1,377.02 |
| MRI chest without contrast | CPT 71550 | $298.90 |
| MRI chest with contrast | CPT 71551 | $288.59 |
| MRI chest with and without contrast | CPT 71552 | $431.50 |
| Lumbosacral spine X-ray | CPT 72100 | $50.72 |
| CT cervical spine without contrast | CPT 72125 | $90.99 |
| CT thoracic spine without contrast | CPT 72128 | $90.99 |
| CT lumbar spine without contrast | CPT 72131 | $90.58 |
| MRI cervical spine without contrast | CPT 72141 | $176.49 |
| MRI thoracic spine without contrast | CPT 72146 | $176.20 |
| MRI lumbar spine without contrast | CPT 72148 | $177.08 |
| MRI lumbar spine with and without contrast | CPT 72149 | $249.56 |
| MRI cervical spine with and without contrast | CPT 72156 | $288.59 |
| MRI lumbar spine with contrast | CPT 72158 | $288.59 |
| CT pelvis without contrast | CPT 72192 | $90.36 |
| CT pelvis with contrast | CPT 72193 | $146.50 |
| Shoulder X-ray | CPT 73030 | $43.97 |
| Humerus X-ray | CPT 73060 | $41.00 |
| Hand X-ray 3 views | CPT 73130 | $46.82 |
| MRI upper extremity joint without contrast | CPT 73221 | $372.89 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $355.34 |
| Knee X-ray 1-2 views | CPT 73560 | $43.47 |
| Ankle X-ray 3 views | CPT 73610 | $46.82 |
| MRI lower extremity joint without contrast | CPT 73721 | $372.32 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $572.40 |
| CT abdomen without contrast | CPT 74150 | $92.91 |
| CT abdomen with contrast | CPT 74160 | $149.47 |
| CT abdomen with and without contrast | CPT 74170 | $1,527.11 |
| CT abdomen and pelvis without contrast | CPT 74176 | $131.15 |
| CT abdomen and pelvis with contrast | CPT 74177 | $194.70 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $239.70 |
| MRI abdomen without contrast | CPT 74181 | $181.09 |
| MRI abdomen with and without contrast | CPT 74183 | $311.32 |
| Abdominal ultrasound complete | CPT 76700 | $148.88 |
| Abdominal ultrasound limited | CPT 76705 | $848.85 |
| Retroperitoneal ultrasound complete | CPT 76770 | $138.71 |
| Obstetric ultrasound first trimester | CPT 76801 | $755.14 |
| Obstetric ultrasound after first trimester | CPT 76805 | $855.05 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $118.29 |
| Transvaginal ultrasound | CPT 76830 | $751.01 |
| Pelvic ultrasound complete | CPT 76856 | $928.08 |
| Scrotal ultrasound | CPT 76870 | $868.83 |
| Diagnostic mammography unilateral | CPT 77065 | $159.20 |
| Diagnostic mammography bilateral | CPT 77066 | $200.39 |
| Screening mammography bilateral | CPT 77067 | $85.52 |
| EKG complete | CPT 93000 | $39.82 |
| EKG tracing only | CPT 93005 | $17.02 |
| EKG interpretation only | CPT 93010 | — |
| Transthoracic echocardiogram complete | CPT 93306 | $302.07 |
| Transthoracic echocardiogram | CPT 93307 | $88.54 |
| Stress echocardiogram | CPT 93350 | $285.65 |
| Initial hospital care, low complexity | CPT 99221 | $88.55 |
| Initial hospital care, moderate complexity | CPT 99222 | $137.91 |
| Initial hospital care, high complexity | CPT 99223 | $184.60 |
| Hospital discharge, <30 min | CPT 99238 | $115.60 |
| Hospital discharge, >30 min | CPT 99239 | $166.80 |
| Basic metabolic panel (BMP) | CPT 80048 | $8.26 |
| General health panel | CPT 80050 | $45.00 |
| Electrolyte panel | CPT 80051 | $6.84 |
| Comprehensive metabolic panel | CPT 80053 | $248.73 |
| Lipid panel | CPT 80061 | $182.76 |
| Renal function panel | CPT 80069 | $322.06 |
| Hepatic function panel | CPT 80076 | $205.76 |
| Urinalysis non-automated | CPT 81002 | $5.06 |
| Urinalysis automated | CPT 81003 | $67.74 |
| Glucose quantitative | CPT 82947 | $66.14 |
| Hemoglobin A1c | CPT 83036 | $55.12 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $205.32 |
| Complete blood count with automated differential | CPT 85025 | $11.17 |
| Complete blood count without differential | CPT 85027 | $102.66 |
| Urine culture bacterial | CPT 87086 | $191.54 |
| Urine culture identification | CPT 87088 | $190.85 |
| Tissue exam by pathologist level IV | CPT 88305 | $265.00 |
| Fetal non-stress test | CPT 59025 | $33.38 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $1,835.33 |
| Vaginal delivery only | CPT 59409 | $917.39 |
| Vaginal delivery with postpartum | CPT 59410 | $921.98 |
| Routine obstetric care with C-section | CPT 59510 | $2,040.84 |
| C-section delivery only | CPT 59514 | $930.56 |
| C-section with postpartum | CPT 59515 | $1,067.59 |
| Office visit, new patient, 15-29 min | CPT 99202 | $141.93 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $285.94 |
| Office visit, new patient, 45-59 min | CPT 99204 | $323.34 |
| Office visit, new patient, 60-74 min | CPT 99205 | $460.25 |
| Office visit, established patient, 5 min | CPT 99211 | $170.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $99.22 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $180.50 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $194.60 |
| Office visit, established patient, 40-54 min | CPT 99215 | $154.60 |
| Upper GI endoscopy diagnostic | CPT 43235 | $424.40 |
| Upper GI endoscopy with biopsy | CPT 43239 | $424.40 |
| Sigmoidoscopy diagnostic | CPT 45330 | $54.58 |
| Sigmoidoscopy with biopsy | CPT 45331 | $424.40 |
| Colonoscopy diagnostic | CPT 45378 | $530.40 |
| Colonoscopy with biopsy | CPT 45380 | $530.40 |
| Colonoscopy with polyp removal | CPT 45385 | $636.60 |
| Total shoulder arthroplasty | CPT 23472 | $1,959.74 |
| Hip hemiarthroplasty | CPT 27125 | $1,023.91 |
| Total hip replacement | CPT 27130 | $1,745.64 |
| Total knee replacement | CPT 27447 | $1,742.76 |
| Knee revision arthroplasty single component | CPT 27486 | $969.53 |
| Knee revision arthroplasty all components | CPT 27487 | $1,469.36 |
| Shoulder arthroscopy with decompression | CPT 29826 | $530.40 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,448.48 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $742.60 |
| ACL reconstruction | CPT 29888 | $1,320.66 |
| CABG single arterial graft | CPT 33533 | $1,861.79 |
| CABG 2 arterial grafts | CPT 33534 | $2,187.83 |
| CABG 3 arterial grafts | CPT 33535 | $2,390.99 |
| CABG 4+ arterial grafts | CPT 33536 | $2,390.99 |
| Open appendectomy | CPT 44950 | $452.09 |
| Laparoscopic appendectomy | CPT 44970 | $848.80 |
| Laparoscopic cholecystectomy | CPT 47562 | $913.44 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $993.56 |
| Lap inguinal hernia repair | CPT 49650 | $742.60 |
| Total abdominal hysterectomy | CPT 58150 | $770.64 |
| Vaginal hysterectomy | CPT 58260 | $723.66 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $723.66 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $723.06 |
| Lap salpingo-oophorectomy | CPT 58661 | $478.72 |
| Complex cataract surgery | CPT 66982 | $586.03 |
| Cataract surgery with lens implant | CPT 66984 | $510.25 |
| Intravitreal injection | CPT 67028 | $86.54 |
| Vitrectomy mechanical | CPT 67042 | $751.45 |
| PCI single major coronary artery | CPT 92920 | $365.84 |
| PCI with drug-eluting stent | CPT 92928 | $407.02 |
| PCI bypass graft | CPT 92937 | $407.10 |
| Left heart catheterization | CPT 93452 | $557.66 |
| Coronary angiography with cath | CPT 93455 | $627.38 |
| Coronary angiography with bypass cath | CPT 93458 | $648.35 |
