| Psychiatric diagnostic evaluation | CPT 90791 | — |
| Psychotherapy 30 minutes | CPT 90832 | — |
| Psychotherapy 45 minutes | CPT 90834 | — |
| Psychotherapy 60 minutes | CPT 90837 | $202.95 |
| ED visit level 1 | CPT 99281 | $23.78 |
| ED visit level 2 | CPT 99282 | $45.11 |
| ED visit level 3 | CPT 99283 | $77 |
| ED visit level 4 | CPT 99284 | $130.87 |
| ED visit level 5 | CPT 99285 | $192.42 |
| Critical care, first hour | CPT 99291 | $233.5 |
| CT head without contrast | CPT 70450 | $916.21 |
| CT head with contrast | CPT 70460 | — |
| CT head with and without contrast | CPT 70470 | $757.83 |
| CT neck with contrast | CPT 70491 | $1,160.14 |
| MRI brain without contrast | CPT 70551 | $933.97 |
| MRI brain with contrast | CPT 70552 | — |
| MRI brain with and without contrast | CPT 70553 | $1,977.12 |
| Chest X-ray single view | CPT 71045 | $101.09 |
| Chest X-ray 2 views | CPT 71046 | $133.91 |
| Chest X-ray 3 views | CPT 71047 | — |
| CT chest without contrast | CPT 71250 | $927.84 |
| CT chest with contrast | CPT 71260 | $1,003.01 |
| CT chest with and without contrast | CPT 71270 | — |
| MRI chest without contrast | CPT 71550 | — |
| MRI chest with contrast | CPT 71551 | — |
| MRI chest with and without contrast | CPT 71552 | — |
| Lumbosacral spine X-ray | CPT 72100 | $185.49 |
| CT cervical spine without contrast | CPT 72125 | $925.71 |
| CT thoracic spine without contrast | CPT 72128 | $694.13 |
| CT lumbar spine without contrast | CPT 72131 | $978.89 |
| MRI cervical spine without contrast | CPT 72141 | $1,346.25 |
| MRI thoracic spine without contrast | CPT 72146 | $968.67 |
| MRI lumbar spine without contrast | CPT 72148 | $1,226.75 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,336.97 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,424.31 |
| MRI lumbar spine with contrast | CPT 72158 | $2,287.48 |
| CT pelvis without contrast | CPT 72192 | $656.37 |
| CT pelvis with contrast | CPT 72193 | — |
| Shoulder X-ray | CPT 73030 | $165.07 |
| Humerus X-ray | CPT 73060 | $113.47 |
| Hand X-ray 3 views | CPT 73130 | $98.86 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,197.3 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,566.25 |
| Knee X-ray 1-2 views | CPT 73560 | $93.46 |
| Ankle X-ray 3 views | CPT 73610 | $106.69 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,168.48 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,374.93 |
| CT abdomen without contrast | CPT 74150 | — |
| CT abdomen with contrast | CPT 74160 | $534.22 |
| CT abdomen with and without contrast | CPT 74170 | $2,129.4 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,838.09 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,830.08 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,309.93 |
| MRI abdomen without contrast | CPT 74181 | — |
| MRI abdomen with and without contrast | CPT 74183 | $1,812.65 |
| Abdominal ultrasound complete | CPT 76700 | $375.01 |
| Abdominal ultrasound limited | CPT 76705 | $285 |
| Retroperitoneal ultrasound complete | CPT 76770 | $343.81 |
| Obstetric ultrasound first trimester | CPT 76801 | $279.61 |
| Obstetric ultrasound after first trimester | CPT 76805 | $316.77 |
| Transvaginal ultrasound | CPT 76830 | $290.79 |
| Pelvic ultrasound complete | CPT 76856 | $339.27 |
| Scrotal ultrasound | CPT 76870 | $300.65 |
| Diagnostic mammography unilateral | CPT 77065 | $197.51 |
| Diagnostic mammography bilateral | CPT 77066 | $238.03 |
| Screening mammography bilateral | CPT 77067 | $138.92 |
| EKG complete | CPT 93000 | — |
| EKG tracing only | CPT 93005 | — |
| EKG interpretation only | CPT 93010 | $9.04 |
| Transthoracic echocardiogram complete | CPT 93306 | $842.81 |
| Transthoracic echocardiogram | CPT 93307 | — |
| Stress echocardiogram | CPT 93350 | $553.2 |
| Initial hospital care, low complexity | CPT 99221 | — |
| Initial hospital care, moderate complexity | CPT 99222 | — |
| Initial hospital care, high complexity | CPT 99223 | — |
| Hospital discharge, <30 min | CPT 99238 | — |
| Hospital discharge, >30 min | CPT 99239 | — |
| Basic metabolic panel (BMP) | CPT 80048 | $68.57 |
| General health panel | CPT 80050 | $275.79 |
| Electrolyte panel | CPT 80051 | $64.29 |
| Comprehensive metabolic panel | CPT 80053 | $99.81 |
| Lipid panel | CPT 80061 | $84.57 |
| Renal function panel | CPT 80069 | $37.37 |
| Hepatic function panel | CPT 80076 | $44.17 |
| Urinalysis automated | CPT 81003 | $18.54 |
| Glucose quantitative | CPT 82947 | $29.11 |
| Hemoglobin A1c | CPT 83036 | $45.39 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | — |
| Complete blood count with automated differential | CPT 85025 | $47.91 |
| Complete blood count without differential | CPT 85027 | $42.29 |
| Urine culture bacterial | CPT 87086 | $49.53 |
| Tissue exam by pathologist level IV | CPT 88305 | $162.32 |
| Fetal non-stress test | CPT 59025 | — |
| Routine obstetric care including vaginal delivery | CPT 59400 | — |
| Vaginal delivery only | CPT 59409 | — |
| Vaginal delivery with postpartum | CPT 59410 | — |
| Office visit, new patient, 15-29 min | CPT 99202 | — |
| Office visit, new patient, 30-44 minutes | CPT 99203 | — |
| Office visit, new patient, 45-59 min | CPT 99204 | — |
| Office visit, new patient, 60-74 min | CPT 99205 | — |
| Office visit, established patient, 5 min | CPT 99211 | — |
| Office visit, established patient, 10-19 min | CPT 99212 | $122.22 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | — |
| Office visit, established patient, 30-39 minutes | CPT 99214 | — |
| Office visit, established patient, 40-54 min | CPT 99215 | — |
| Upper GI endoscopy diagnostic | CPT 43235 | $887.93 |
| Upper GI endoscopy with biopsy | CPT 43239 | $480.75 |
| Sigmoidoscopy diagnostic | CPT 45330 | — |
| Sigmoidoscopy with biopsy | CPT 45331 | — |
| Colonoscopy diagnostic | CPT 45378 | — |
| Colonoscopy with biopsy | CPT 45380 | — |
| Colonoscopy with polyp removal | CPT 45385 | — |
| Total shoulder arthroplasty | CPT 23472 | — |
| Hip hemiarthroplasty | CPT 27125 | — |
| Total hip replacement | CPT 27130 | — |
| Total knee replacement | CPT 27447 | $21,397 |
| Shoulder arthroscopy with decompression | CPT 29826 | $2,612.93 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | — |
| Knee arthroscopy with meniscectomy | CPT 29881 | $1,022.47 |
| Open appendectomy | CPT 44950 | — |
| Laparoscopic appendectomy | CPT 44970 | — |
| Laparoscopic cholecystectomy | CPT 47562 | $2,584.72 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $5,932.76 |
| Open umbilical hernia repair | CPT 49560 | — |
| Umbilical hernia repair age 5+ | CPT 49585 | $2,463.25 |
| Total abdominal hysterectomy | CPT 58150 | — |
| Vaginal hysterectomy | CPT 58260 | — |
| Lap-assisted vaginal hysterectomy | CPT 58550 | — |
| Lap salpingo-oophorectomy | CPT 58661 | — |
| Complex cataract surgery | CPT 66982 | — |
| Cataract surgery with lens implant | CPT 66984 | $1,568.49 |
