| Psychiatric diagnostic evaluation | CPT 90791 | $379.10 |
| Psychiatric eval with medical services | CPT 90792 | $251.97 |
| Psychotherapy 30 minutes | CPT 90832 | $303.62 |
| Psychotherapy 45 minutes | CPT 90834 | $216.20 |
| Psychotherapy 60 minutes | CPT 90837 | $326.87 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $287.77 |
| ED visit level 1 | CPT 99281 | $264.60 |
| ED visit level 2 | CPT 99282 | $390.46 |
| ED visit level 3 | CPT 99283 | $543.92 |
| ED visit level 4 | CPT 99284 | $1,010.05 |
| ED visit level 5 | CPT 99285 | $1,411.20 |
| Critical care, first hour | CPT 99291 | $448.39 |
| CT head without contrast | CPT 70450 | $984.09 |
| CT head with contrast | CPT 70460 | $657.00 |
| CT head with and without contrast | CPT 70470 | $657.00 |
| CT neck with contrast | CPT 70491 | $657.00 |
| MRI brain without contrast | CPT 70551 | $1,463.86 |
| MRI brain with contrast | CPT 70552 | $1,463.86 |
| MRI brain with and without contrast | CPT 70553 | $1,705.00 |
| Chest X-ray single view | CPT 71045 | $198.20 |
| Chest X-ray 2 views | CPT 71046 | $263.24 |
| CT chest without contrast | CPT 71250 | $911.38 |
| CT chest with contrast | CPT 71260 | $1,054.50 |
| CT chest with and without contrast | CPT 71270 | $876.00 |
| MRI chest without contrast | CPT 71550 | $2,302.45 |
| MRI chest with contrast | CPT 71551 | $2,692.86 |
| MRI chest with and without contrast | CPT 71552 | $3,313.62 |
| Lumbosacral spine X-ray | CPT 72100 | $368.00 |
| CT cervical spine without contrast | CPT 72125 | $975.63 |
| CT thoracic spine without contrast | CPT 72128 | $524.00 |
| CT lumbar spine without contrast | CPT 72131 | $671.43 |
| MRI cervical spine without contrast | CPT 72141 | $2,692.86 |
| MRI thoracic spine without contrast | CPT 72146 | $1,169.00 |
| MRI lumbar spine without contrast | CPT 72148 | $2,692.86 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,375.50 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,520.76 |
| MRI lumbar spine with contrast | CPT 72158 | $1,834.00 |
| CT pelvis without contrast | CPT 72192 | $1,055.70 |
| CT pelvis with contrast | CPT 72193 | $1,733.33 |
| Shoulder X-ray | CPT 73030 | $150.15 |
| Humerus X-ray | CPT 73060 | $207.99 |
| Hand X-ray 3 views | CPT 73130 | $208.48 |
| MRI upper extremity joint without contrast | CPT 73221 | $916.20 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,375.50 |
| Knee X-ray 1-2 views | CPT 73560 | — |
| Ankle X-ray 3 views | CPT 73610 | $295.20 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,423.50 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,375.50 |
| CT abdomen without contrast | CPT 74150 | $393.00 |
| CT abdomen with contrast | CPT 74160 | $566.09 |
| CT abdomen with and without contrast | CPT 74170 | $657.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,733.33 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,830.50 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,135.34 |
| MRI abdomen without contrast | CPT 74181 | $876.75 |
| MRI abdomen with and without contrast | CPT 74183 | $1,856.00 |
| Abdominal ultrasound complete | CPT 76700 | $958.46 |
| Abdominal ultrasound limited | CPT 76705 | $187.62 |
| Retroperitoneal ultrasound complete | CPT 76770 | $881.35 |
| Obstetric ultrasound first trimester | CPT 76801 | $436.28 |
| Obstetric ultrasound after first trimester | CPT 76805 | $629.27 |
| Transvaginal ultrasound | CPT 76830 | $567.00 |
| Pelvic ultrasound complete | CPT 76856 | $679.95 |
| Scrotal ultrasound | CPT 76870 | $83.39 |
| Diagnostic mammography unilateral | CPT 77065 | $332.46 |
| Diagnostic mammography bilateral | CPT 77066 | $288.36 |
| Screening mammography bilateral | CPT 77067 | $296.97 |
| EKG tracing only | CPT 93005 | $112.00 |
| EKG interpretation only | CPT 93010 | $9.41 |
| Transthoracic echocardiogram complete | CPT 93306 | $395.66 |
| Transthoracic echocardiogram | CPT 93307 | $1,961.53 |
| Initial hospital care, low complexity | CPT 99221 | $270.07 |
| Initial hospital care, moderate complexity | CPT 99222 | $366.72 |
| Initial hospital care, high complexity | CPT 99223 | $468.82 |
| Hospital discharge, <30 min | CPT 99238 | $201.06 |
| Hospital discharge, >30 min | CPT 99239 | $296.71 |
| Basic metabolic panel (BMP) | CPT 80048 | $157.02 |
| Electrolyte panel | CPT 80051 | $133.40 |
| Comprehensive metabolic panel | CPT 80053 | $204.39 |
| Lipid panel | CPT 80061 | $100.08 |
| Renal function panel | CPT 80069 | $142.63 |
| Hepatic function panel | CPT 80076 | $161.00 |
| Urinalysis automated | CPT 81003 | $40.10 |
| Glucose quantitative | CPT 82947 | $27.60 |
| Hemoglobin A1c | CPT 83036 | $76.07 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $112.95 |
| Complete blood count with automated differential | CPT 85025 | $114.48 |
| Complete blood count without differential | CPT 85027 | $68.30 |
| Urine culture bacterial | CPT 87086 | $83.72 |
| Tissue exam by pathologist level IV | CPT 88305 | $253.96 |
| Office visit, new patient, 15-29 min | CPT 99202 | $212.77 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $304.52 |
| Office visit, new patient, 45-59 min | CPT 99204 | $459.71 |
| Office visit, new patient, 60-74 min | CPT 99205 | $560.24 |
| Office visit, established patient, 5 min | CPT 99211 | $26.97 |
| Office visit, established patient, 10-19 min | CPT 99212 | $317.28 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $305.14 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $168.78 |
| Office visit, established patient, 40-54 min | CPT 99215 | $408.98 |
| Upper GI endoscopy diagnostic | CPT 43235 | $259.12 |
| Upper GI endoscopy with biopsy | CPT 43239 | $459.30 |
| Sigmoidoscopy diagnostic | CPT 45330 | $167.50 |
| Colonoscopy diagnostic | CPT 45378 | $390.47 |
| Colonoscopy with biopsy | CPT 45380 | $449.56 |
| Colonoscopy with polyp removal | CPT 45385 | $615.27 |
| Total shoulder arthroplasty | CPT 23472 | $2,561.23 |
| Total hip replacement | CPT 27130 | $2,386.13 |
| Total knee replacement | CPT 27447 | $2,384.91 |
| Knee revision arthroplasty single component | CPT 27486 | $2,474.60 |
| Knee revision arthroplasty all components | CPT 27487 | $3,095.08 |
| Shoulder arthroscopy with decompression | CPT 29826 | $311.16 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,852.29 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $949.33 |
| Laparoscopic appendectomy | CPT 44970 | $1,060.37 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,161.04 |
| Lap inguinal hernia repair | CPT 49650 | $754.70 |
| Vaginal hysterectomy | CPT 58260 | $1,431.31 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $1,528.32 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,129.92 |
