| Psychiatric eval with medical services | CPT 90792 | $337.02 |
| Psychotherapy 30 minutes | CPT 90832 | $500.20 |
| Psychotherapy 45 minutes | CPT 90834 | $619.10 |
| Psychotherapy 60 minutes | CPT 90837 | $631.40 |
| ED visit level 1 | CPT 99281 | $57.40 |
| ED visit level 2 | CPT 99282 | $112.34 |
| ED visit level 3 | CPT 99283 | $238.62 |
| ED visit level 4 | CPT 99284 | $316.52 |
| ED visit level 5 | CPT 99285 | $466.58 |
| Critical care, first hour | CPT 99291 | $558.42 |
| CT head without contrast | CPT 70450 | $1,256.24 |
| CT head with contrast | CPT 70460 | $186.14 |
| CT head with and without contrast | CPT 70470 | $209.10 |
| CT neck with contrast | CPT 70491 | $226.32 |
| MRI brain without contrast | CPT 70551 | $242.72 |
| MRI brain with contrast | CPT 70552 | $291.92 |
| MRI brain with and without contrast | CPT 70553 | $385.40 |
| Chest X-ray single view | CPT 71045 | $22.14 |
| Chest X-ray 2 views | CPT 71046 | $38.54 |
| Chest X-ray 3 views | CPT 71047 | $48.38 |
| CT chest without contrast | CPT 71250 | $1,498.96 |
| CT chest with contrast | CPT 71260 | $205.00 |
| CT chest with and without contrast | CPT 71270 | $226.32 |
| MRI chest without contrast | CPT 71550 | $2,384.56 |
| MRI chest with contrast | CPT 71551 | $282.90 |
| MRI chest with and without contrast | CPT 71552 | $369.00 |
| Lumbosacral spine X-ray | CPT 72100 | $38.54 |
| CT cervical spine without contrast | CPT 72125 | $176.30 |
| CT thoracic spine without contrast | CPT 72128 | $164.82 |
| CT lumbar spine without contrast | CPT 72131 | $164.82 |
| MRI cervical spine without contrast | CPT 72141 | $263.22 |
| MRI thoracic spine without contrast | CPT 72146 | $263.22 |
| MRI lumbar spine without contrast | CPT 72148 | $242.72 |
| MRI lumbar spine with and without contrast | CPT 72149 | $291.92 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,654.32 |
| MRI lumbar spine with contrast | CPT 72158 | $385.40 |
| CT pelvis without contrast | CPT 72192 | $179.58 |
| CT pelvis with contrast | CPT 72193 | $191.88 |
| Shoulder X-ray | CPT 73030 | $84.46 |
| Humerus X-ray | CPT 73060 | $84.46 |
| Hand X-ray 3 views | CPT 73130 | $197.62 |
| MRI upper extremity joint without contrast | CPT 73221 | $222.22 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $350.96 |
| Knee X-ray 1-2 views | CPT 73560 | $32.80 |
| Ankle X-ray 3 views | CPT 73610 | $32.80 |
| MRI lower extremity joint without contrast | CPT 73721 | $367.36 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $576.46 |
| CT abdomen without contrast | CPT 74150 | $1,574.40 |
| CT abdomen with contrast | CPT 74160 | $209.10 |
| CT abdomen with and without contrast | CPT 74170 | $229.60 |
| CT abdomen and pelvis without contrast | CPT 74176 | $285.36 |
| CT abdomen and pelvis with contrast | CPT 74177 | $298.48 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $328.00 |
| MRI abdomen without contrast | CPT 74181 | $239.44 |
| MRI abdomen with and without contrast | CPT 74183 | $369.00 |
| Abdominal ultrasound complete | CPT 76700 | $134.48 |
| Abdominal ultrasound limited | CPT 76705 | $99.22 |
| Retroperitoneal ultrasound complete | CPT 76770 | $123.82 |
| Obstetric ultrasound first trimester | CPT 76801 | $163.18 |
| Obstetric ultrasound after first trimester | CPT 76805 | $163.18 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $310.78 |
| Transvaginal ultrasound | CPT 76830 | $115.62 |
| Pelvic ultrasound complete | CPT 76856 | $115.62 |
| Scrotal ultrasound | CPT 76870 | $202.54 |
| Diagnostic mammography unilateral | CPT 77065 | $116.44 |
| Diagnostic mammography bilateral | CPT 77066 | $145.14 |
| Screening mammography bilateral | CPT 77067 | $116.44 |
| EKG complete | CPT 93000 | $32.80 |
| EKG tracing only | CPT 93005 | $14.76 |
| EKG interpretation only | CPT 93010 | $18.04 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,435.00 |
| Transthoracic echocardiogram | CPT 93307 | $605.98 |
| Initial hospital care, low complexity | CPT 99221 | $186.14 |
| Initial hospital care, moderate complexity | CPT 99222 | $296.02 |
| Initial hospital care, high complexity | CPT 99223 | $394.42 |
| Hospital discharge, <30 min | CPT 99238 | $185.32 |
| Hospital discharge, >30 min | CPT 99239 | $262.40 |
| Basic metabolic panel (BMP) | CPT 80048 | $104.14 |
| Electrolyte panel | CPT 80051 | $83.64 |
| Comprehensive metabolic panel | CPT 80053 | $123.82 |
| Lipid panel | CPT 80061 | $126.28 |
| Renal function panel | CPT 80069 | $86.92 |
| Hepatic function panel | CPT 80076 | $67.24 |
| Urinalysis automated | CPT 81003 | $31.98 |
| Glucose quantitative | CPT 82947 | $78.72 |
| Hemoglobin A1c | CPT 83036 | $95.94 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $164.00 |
| Complete blood count with automated differential | CPT 85025 | $268.96 |
| Complete blood count without differential | CPT 85027 | $127.92 |
| Urine culture bacterial | CPT 87086 | $100.04 |
| Urine culture identification | CPT 87088 | $83.64 |
| Tissue exam by pathologist level IV | CPT 88305 | $127.01 |
| Fetal non-stress test | CPT 59025 | $299.30 |
| Vaginal delivery only | CPT 59409 | $1,741.68 |
| Vaginal delivery with postpartum | CPT 59410 | $2,357.48 |
| C-section delivery only | CPT 59514 | $2,861.80 |
| Office visit, new patient, 15-29 min | CPT 99202 | $41.82 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $64.78 |
| Office visit, new patient, 45-59 min | CPT 99204 | $96.76 |
| Office visit, new patient, 60-74 min | CPT 99205 | $127.92 |
| Office visit, established patient, 5 min | CPT 99211 | $1,044.68 |
| Office visit, established patient, 10-19 min | CPT 99212 | $32.80 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $53.30 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $74.62 |
| Office visit, established patient, 40-54 min | CPT 99215 | $104.14 |
| Upper GI endoscopy diagnostic | CPT 43235 | $637.14 |
| Upper GI endoscopy with biopsy | CPT 43239 | $863.46 |
| Sigmoidoscopy diagnostic | CPT 45330 | $437.06 |
| Sigmoidoscopy with biopsy | CPT 45331 | $660.92 |
| Colonoscopy diagnostic | CPT 45378 | $784.74 |
| Colonoscopy with biopsy | CPT 45380 | $996.30 |
| Colonoscopy with polyp removal | CPT 45385 | $1,042.22 |
| Total shoulder arthroplasty | CPT 23472 | $77.50 |
| Total hip replacement | CPT 27130 | $2,911.82 |
| Total knee replacement | CPT 27447 | $2,907.72 |
| Knee revision arthroplasty all components | CPT 27487 | $3,959.78 |
| Shoulder arthroscopy with decompression | CPT 29826 | $382.12 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $2,441.14 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $1,258.70 |
| Laparoscopic appendectomy | CPT 44970 | $1,350.54 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,477.64 |
| Lap inguinal hernia repair | CPT 49650 | $979.90 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,471.08 |
