| Psychiatric diagnostic evaluation | CPT 90791 | $148.51 |
| Psychiatric eval with medical services | CPT 90792 | $197.74 |
| Psychotherapy 30 minutes | CPT 90832 | $71.59 |
| Psychotherapy 45 minutes | CPT 90834 | $108.36 |
| Psychotherapy 60 minutes | CPT 90837 | $142.95 |
| Crisis psychotherapy 60 minutes | CPT 90839 | $190.13 |
| ED visit level 1 | CPT 99281 | $90.94 |
| ED visit level 2 | CPT 99282 | $81.17 |
| ED visit level 3 | CPT 99283 | $102.5 |
| ED visit level 4 | CPT 99284 | $152.71 |
| ED visit level 5 | CPT 99285 | $221.98 |
| Critical care, first hour | CPT 99291 | $402.39 |
| CT head without contrast | CPT 70450 | — |
| CT head with contrast | CPT 70460 | — |
| CT head with and without contrast | CPT 70470 | — |
| CT neck with contrast | CPT 70491 | — |
| MRI brain without contrast | CPT 70551 | — |
| MRI brain with contrast | CPT 70552 | — |
| MRI brain with and without contrast | CPT 70553 | — |
| Chest X-ray single view | CPT 71045 | — |
| Chest X-ray 2 views | CPT 71046 | — |
| Chest X-ray 3 views | CPT 71047 | — |
| CT chest without contrast | CPT 71250 | — |
| CT chest with contrast | CPT 71260 | — |
| 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 | — |
| CT cervical spine without contrast | CPT 72125 | — |
| CT thoracic spine without contrast | CPT 72128 | — |
| CT lumbar spine without contrast | CPT 72131 | — |
| MRI cervical spine without contrast | CPT 72141 | — |
| MRI thoracic spine without contrast | CPT 72146 | — |
| MRI lumbar spine without contrast | CPT 72148 | — |
| MRI lumbar spine with and without contrast | CPT 72149 | — |
| MRI cervical spine with and without contrast | CPT 72156 | — |
| MRI lumbar spine with contrast | CPT 72158 | — |
| CT pelvis without contrast | CPT 72192 | — |
| CT pelvis with contrast | CPT 72193 | — |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | — |
| Hand X-ray 3 views | CPT 73130 | — |
| MRI upper extremity joint without contrast | CPT 73221 | — |
| MRI upper extremity joint with and without contrast | CPT 73223 | — |
| Hip X-ray 2 views | CPT 73510 | $51 |
| Knee X-ray 1-2 views | CPT 73560 | — |
| Ankle X-ray 3 views | CPT 73610 | — |
| MRI lower extremity joint without contrast | CPT 73721 | — |
| MRI lower extremity joint with and without contrast | CPT 73723 | — |
| CT abdomen without contrast | CPT 74150 | — |
| CT abdomen with contrast | CPT 74160 | — |
| CT abdomen with and without contrast | CPT 74170 | — |
| CT abdomen and pelvis without contrast | CPT 74176 | — |
| CT abdomen and pelvis with contrast | CPT 74177 | — |
| CT abdomen and pelvis with and without contrast | CPT 74178 | — |
| MRI abdomen without contrast | CPT 74181 | — |
| MRI abdomen with and without contrast | CPT 74183 | — |
| Abdominal ultrasound complete | CPT 76700 | — |
| Abdominal ultrasound limited | CPT 76705 | — |
| Retroperitoneal ultrasound complete | CPT 76770 | — |
| Obstetric ultrasound first trimester | CPT 76801 | — |
| Obstetric ultrasound after first trimester | CPT 76805 | — |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | — |
| Transvaginal ultrasound | CPT 76830 | — |
| Pelvic ultrasound complete | CPT 76856 | — |
| Scrotal ultrasound | CPT 76870 | — |
| Diagnostic mammography unilateral | CPT 77065 | — |
| Diagnostic mammography bilateral | CPT 77066 | — |
| Screening mammography bilateral | CPT 77067 | — |
| EKG complete | CPT 93000 | $20.18 |
| EKG tracing only | CPT 93005 | $6.8 |
| EKG interpretation only | CPT 93010 | $9.61 |
| Transthoracic echocardiogram complete | CPT 93306 | $212.4 |
| Transthoracic echocardiogram | CPT 93307 | $151.73 |
| Stress echocardiogram | CPT 93350 | $152.33 |
| Initial hospital care, low complexity | CPT 99221 | $87.81 |
| Initial hospital care, moderate complexity | CPT 99222 | $138.5 |
| Initial hospital care, high complexity | CPT 99223 | $183.47 |
| Hospital discharge, <30 min | CPT 99238 | $81.32 |
| Hospital discharge, >30 min | CPT 99239 | $117.22 |
| Basic metabolic panel (BMP) | CPT 80048 | — |
| General health panel | CPT 80050 | $57.02 |
| Electrolyte panel | CPT 80051 | — |
| Comprehensive metabolic panel | CPT 80053 | — |
| Lipid panel | CPT 80061 | — |
| Renal function panel | CPT 80069 | — |
| Hepatic function panel | CPT 80076 | — |
| Urinalysis non-automated | CPT 81002 | — |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | — |
| Hemoglobin A1c | CPT 83036 | — |
| Thyroid stimulating hormone (TSH) | CPT 84443 | — |
| Complete blood count with automated differential | CPT 85025 | — |
| Complete blood count without differential | CPT 85027 | — |
| Urine culture bacterial | CPT 87086 | — |
| Urine culture identification | CPT 87088 | — |
| Tissue exam by pathologist level IV | CPT 88305 | — |
| Fetal non-stress test | CPT 59025 | $35.82 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $3,100.76 |
| Vaginal delivery only | CPT 59409 | $1,920 |
| Vaginal delivery with postpartum | CPT 59410 | $1,740 |
| Routine obstetric care with C-section | CPT 59510 | $3,100.76 |
| C-section delivery only | CPT 59514 | $1,124.94 |
| C-section with postpartum | CPT 59515 | $1,740 |
| Office visit, new patient, 15-29 min | CPT 99202 | $52.41 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $81.21 |
| Office visit, new patient, 45-59 min | CPT 99204 | $132.25 |
| Office visit, new patient, 60-74 min | CPT 99205 | $176.31 |
| Office visit, established patient, 5 min | CPT 99211 | $32 |
| Office visit, established patient, 10-19 min | CPT 99212 | $46.82 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $66 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $92 |
| Office visit, established patient, 40-54 min | CPT 99215 | $131.47 |
| Upper GI endoscopy diagnostic | CPT 43235 | $237.27 |
| Upper GI endoscopy with biopsy | CPT 43239 | $267.54 |
| Sigmoidoscopy diagnostic | CPT 45330 | $265.21 |
| Sigmoidoscopy with biopsy | CPT 45331 | $239.1 |
| Colonoscopy diagnostic | CPT 45378 | $290.37 |
| Colonoscopy with biopsy | CPT 45380 | $388.65 |
| Colonoscopy with polyp removal | CPT 45385 | $493.58 |
| Total shoulder arthroplasty | CPT 23472 | $1,881.3 |
| Hip hemiarthroplasty | CPT 27125 | $1,020.6 |
| Total hip replacement | CPT 27130 | $1,627.65 |
| Total knee replacement | CPT 27447 | $1,625.12 |
| Knee revision arthroplasty single component | CPT 27486 | $1,138.09 |
| Knee revision arthroplasty all components | CPT 27487 | $1,262.22 |
| Shoulder arthroscopy with decompression | CPT 29826 | $220.92 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,321.06 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $867.71 |
| ACL reconstruction | CPT 29888 | $1,274.42 |
| CABG single arterial graft | CPT 33533 | $1,450 |
| CABG 2 arterial grafts | CPT 33534 | $1,579.58 |
| CABG 3 arterial grafts | CPT 33535 | $1,600 |
| CABG 4+ arterial grafts | CPT 33536 | $1,704.54 |
| Open appendectomy | CPT 44950 | $728.31 |
| Laparoscopic appendectomy | CPT 44970 | $685.33 |
| Laparoscopic cholecystectomy | CPT 47562 | $854.56 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $919.21 |
| Lap inguinal hernia repair | CPT 49650 | $495.03 |
| Total abdominal hysterectomy | CPT 58150 | $751.83 |
| Vaginal hysterectomy | CPT 58260 | $1,004.78 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $1,057.47 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $1,172.71 |
| Lap salpingo-oophorectomy | CPT 58661 | $819.34 |
| Complex cataract surgery | CPT 66982 | $1,337.2 |
| Cataract surgery with lens implant | CPT 66984 | $964.05 |
| Intravitreal injection | CPT 67028 | $176.37 |
| Vitrectomy mechanical | CPT 67042 | $1,505.12 |
| PCI single major coronary artery | CPT 92920 | $1,241.6 |
| PCI with drug-eluting stent | CPT 92928 | $1,241.6 |
| PCI bypass graft | CPT 92937 | $1,241.6 |
| Left heart catheterization | CPT 93452 | $1,024.45 |
| Coronary angiography with cath | CPT 93455 | $1,154.13 |
| Coronary angiography with bypass cath | CPT 93458 | $1,193.68 |
