| Psychiatric diagnostic evaluation | CPT 90791 | $242.78 |
| Psychiatric eval with medical services | CPT 90792 | $257.01 |
| Psychotherapy 30 minutes | CPT 90832 | $246.48 |
| Psychotherapy 45 minutes | CPT 90834 | $246.48 |
| Psychotherapy 60 minutes | CPT 90837 | $245.31 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $237.9 |
| ED visit level 1 | CPT 99281 | $280.2 |
| ED visit level 2 | CPT 99282 | $485.4 |
| ED visit level 3 | CPT 99283 | $985.8 |
| ED visit level 4 | CPT 99284 | $1,645.2 |
| ED visit level 5 | CPT 99285 | $2,406.98 |
| Critical care, first hour | CPT 99291 | $3,548.26 |
| CT head without contrast | CPT 70450 | $1,285.91 |
| CT head with contrast | CPT 70460 | $2,279 |
| CT head with and without contrast | CPT 70470 | $3,282 |
| CT neck with contrast | CPT 70491 | $425.78 |
| MRI brain without contrast | CPT 70551 | $2,467.2 |
| MRI brain with contrast | CPT 70552 | $2,467.2 |
| MRI brain with and without contrast | CPT 70553 | $2,960.44 |
| Chest X-ray single view | CPT 71045 | $162.4 |
| Chest X-ray 2 views | CPT 71046 | $162.4 |
| Chest X-ray 3 views | CPT 71047 | $660.44 |
| CT chest without contrast | CPT 71250 | $3,043.8 |
| CT chest with contrast | CPT 71260 | $3,073.22 |
| CT chest with and without contrast | CPT 71270 | $442.15 |
| MRI chest without contrast | CPT 71550 | $1,308.05 |
| MRI chest with contrast | CPT 71551 | $1,626.02 |
| MRI chest with and without contrast | CPT 71552 | $1,569.46 |
| Lumbosacral spine X-ray | CPT 72100 | $175.21 |
| CT cervical spine without contrast | CPT 72125 | $3,624.03 |
| CT thoracic spine without contrast | CPT 72128 | $253.78 |
| CT lumbar spine without contrast | CPT 72131 | $3,874.09 |
| MRI cervical spine without contrast | CPT 72141 | $2,286.9 |
| MRI thoracic spine without contrast | CPT 72146 | $2,445.61 |
| MRI lumbar spine without contrast | CPT 72148 | $2,696.42 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,263 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,661.75 |
| MRI lumbar spine with contrast | CPT 72158 | $3,798.04 |
| CT pelvis without contrast | CPT 72192 | $2,402.56 |
| CT pelvis with contrast | CPT 72193 | $2,391 |
| Shoulder X-ray | CPT 73030 | $105.7 |
| Humerus X-ray | CPT 73060 | $162.4 |
| Hand X-ray 3 views | CPT 73130 | $156.65 |
| MRI upper extremity joint without contrast | CPT 73221 | $3,376.61 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,784.43 |
| Knee X-ray 1-2 views | CPT 73560 | $104.3 |
| Ankle X-ray 3 views | CPT 73610 | $104.3 |
| MRI lower extremity joint without contrast | CPT 73721 | $3,062.32 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,674.78 |
| CT abdomen without contrast | CPT 74150 | $2,889.6 |
| CT abdomen with contrast | CPT 74160 | $1,842.12 |
| CT abdomen with and without contrast | CPT 74170 | $2,889.5 |
| CT abdomen and pelvis without contrast | CPT 74176 | $477.83 |
| CT abdomen and pelvis with contrast | CPT 74177 | $6,524.1 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,226.5 |
| MRI abdomen without contrast | CPT 74181 | $3,044.15 |
| MRI abdomen with and without contrast | CPT 74183 | $2,924.55 |
| Abdominal ultrasound complete | CPT 76700 | $1,899.6 |
| Abdominal ultrasound limited | CPT 76705 | $160.3 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,358.2 |
| Obstetric ultrasound first trimester | CPT 76801 | $172 |
| Obstetric ultrasound after first trimester | CPT 76805 | $200.2 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $411.88 |
| Transvaginal ultrasound | CPT 76830 | $188.47 |
| Pelvic ultrasound complete | CPT 76856 | $188.47 |
| Scrotal ultrasound | CPT 76870 | $1,215.84 |
| Diagnostic mammography unilateral | CPT 77065 | $322.91 |
| Diagnostic mammography bilateral | CPT 77066 | $801.72 |
| Screening mammography bilateral | CPT 77067 | $245 |
| EKG tracing only | CPT 93005 | $102.84 |
| Transthoracic echocardiogram complete | CPT 93306 | $624.41 |
| Transthoracic echocardiogram | CPT 93307 | $1,009 |
| Stress echocardiogram | CPT 93350 | $631.29 |
| Basic metabolic panel (BMP) | CPT 80048 | $81.99 |
| General health panel | CPT 80050 | $96.93 |
| Electrolyte panel | CPT 80051 | $65.8 |
| Comprehensive metabolic panel | CPT 80053 | $34.3 |
| Lipid panel | CPT 80061 | $46.56 |
| Renal function panel | CPT 80069 | $143.5 |
| Hepatic function panel | CPT 80076 | $52.79 |
| Urinalysis non-automated | CPT 81002 | $11.2 |
| Urinalysis automated | CPT 81003 | $4.2 |
| Glucose quantitative | CPT 82947 | $7.7 |
| Hemoglobin A1c | CPT 83036 | $31.5 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $55.3 |
| Complete blood count with automated differential | CPT 85025 | $27.34 |
| Complete blood count without differential | CPT 85027 | $116.2 |
| Urine culture bacterial | CPT 87086 | $72.8 |
| Tissue exam by pathologist level IV | CPT 88305 | $85.73 |
| Fetal non-stress test | CPT 59025 | $265.3 |
| Vaginal delivery only | CPT 59409 | $3,438.4 |
| C-section delivery only | CPT 59514 | $4,332.68 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $133 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $508.84 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,286.34 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,809.48 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,074.39 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,106.74 |
| Colonoscopy diagnostic | CPT 45378 | $1,419.96 |
| Colonoscopy with biopsy | CPT 45380 | $1,872.78 |
| Colonoscopy with polyp removal | CPT 45385 | $1,872.78 |
| Total shoulder arthroplasty | CPT 23472 | $16,370 |
| Total hip replacement | CPT 27130 | $11,987 |
| Total knee replacement | CPT 27447 | $20,246 |
| Knee revision arthroplasty all components | CPT 27487 | $16,370 |
| Shoulder arthroscopy with decompression | CPT 29826 | $6,842.39 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $5,290.46 |
| Open appendectomy | CPT 44950 | $6,044.17 |
| Laparoscopic appendectomy | CPT 44970 | $8,977.36 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $8,977.36 |
| Lap inguinal hernia repair | CPT 49650 | $8,977.36 |
| Total abdominal hysterectomy | CPT 58150 | $2,283.5 |
| Vaginal hysterectomy | CPT 58260 | $8,223.62 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $15,191 |
| Lap salpingo-oophorectomy | CPT 58661 | $8,977.36 |
| Complex cataract surgery | CPT 66982 | $1,637.54 |
| Cataract surgery with lens implant | CPT 66984 | $1,659.09 |
| Intravitreal injection | CPT 67028 | $590.83 |
| Vitrectomy mechanical | CPT 67042 | $2,971.51 |
| PCI single major coronary artery | CPT 92920 | $11,398 |
| PCI with drug-eluting stent | CPT 92928 | $20,264 |
| PCI bypass graft | CPT 92937 | $18,377 |
| Left heart catheterization | CPT 93452 | $5,750.87 |
| Coronary angiography with cath | CPT 93455 | $8,396.28 |
| Coronary angiography with bypass cath | CPT 93458 | $10,972 |
