| Psychotherapy 30 minutes | CPT 90832 | $481.90 |
| Psychotherapy 45 minutes | CPT 90834 | $596.45 |
| Psychotherapy 60 minutes | CPT 90837 | $608.30 |
| ED visit level 1 | CPT 99281 | $59.25 |
| ED visit level 2 | CPT 99282 | $114.55 |
| ED visit level 3 | CPT 99283 | $173.01 |
| ED visit level 4 | CPT 99284 | $319.95 |
| ED visit level 5 | CPT 99285 | $477.16 |
| Critical care, first hour | CPT 99291 | $537.99 |
| CT head without contrast | CPT 70450 | $1,620.29 |
| CT head with contrast | CPT 70460 | $1,620.29 |
| CT head with and without contrast | CPT 70470 | $2,284.68 |
| CT neck with contrast | CPT 70491 | $1,448.07 |
| MRI brain without contrast | CPT 70551 | $2,454.53 |
| MRI brain with contrast | CPT 70552 | $2,454.53 |
| MRI brain with and without contrast | CPT 70553 | $3,556.58 |
| Chest X-ray single view | CPT 71045 | $194.34 |
| Chest X-ray 2 views | CPT 71046 | $304.94 |
| Chest X-ray 3 views | CPT 71047 | $270.18 |
| CT chest without contrast | CPT 71250 | $1,534.18 |
| CT chest with contrast | CPT 71260 | $1,534.18 |
| CT chest with and without contrast | CPT 71270 | $2,407.92 |
| MRI chest without contrast | CPT 71550 | $1,791.72 |
| MRI chest with contrast | CPT 71551 | $1,790.14 |
| MRI chest with and without contrast | CPT 71552 | $2,862.17 |
| Lumbosacral spine X-ray | CPT 72100 | $399.74 |
| CT cervical spine without contrast | CPT 72125 | $1,725.36 |
| CT thoracic spine without contrast | CPT 72128 | $1,725.36 |
| CT lumbar spine without contrast | CPT 72131 | $1,627.40 |
| MRI cervical spine without contrast | CPT 72141 | $2,500.35 |
| MRI thoracic spine without contrast | CPT 72146 | $2,500.35 |
| MRI lumbar spine without contrast | CPT 72148 | $2,447.42 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,447.42 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,224.92 |
| MRI lumbar spine with contrast | CPT 72158 | $4,135.65 |
| CT pelvis without contrast | CPT 72192 | $1,711.93 |
| CT pelvis with contrast | CPT 72193 | $1,711.93 |
| CT abdomen without contrast | CPT 74150 | $1,472.56 |
| CT abdomen with contrast | CPT 74160 | $1,472.56 |
| CT abdomen with and without contrast | CPT 74170 | $2,061.90 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,975.14 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,975.14 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,630.05 |
| MRI abdomen without contrast | CPT 74181 | $2,090.34 |
| MRI abdomen with and without contrast | CPT 74183 | $3,638.74 |
| Abdominal ultrasound complete | CPT 76700 | $642.27 |
| Abdominal ultrasound limited | CPT 76705 | $518.24 |
| Retroperitoneal ultrasound complete | CPT 76770 | $514.29 |
| Obstetric ultrasound first trimester | CPT 76801 | $65.57 |
| Obstetric ultrasound after first trimester | CPT 76805 | $542.73 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $626.47 |
| Transvaginal ultrasound | CPT 76830 | $519.03 |
| Pelvic ultrasound complete | CPT 76856 | $425.02 |
| Scrotal ultrasound | CPT 76870 | $483.48 |
| Diagnostic mammography bilateral | CPT 77066 | $614.62 |
| Screening mammography bilateral | CPT 77067 | $884.80 |
| EKG complete | CPT 93000 | $31.60 |
| EKG tracing only | CPT 93005 | $14.22 |
| EKG interpretation only | CPT 93010 | $26.86 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,090.99 |
| Transthoracic echocardiogram | CPT 93307 | $977.23 |
| Initial hospital care, low complexity | CPT 99221 | $317.58 |
| Initial hospital care, moderate complexity | CPT 99222 | $430.55 |
| Initial hospital care, high complexity | CPT 99223 | $633.58 |
| Hospital discharge, <30 min | CPT 99238 | $178.54 |
| Hospital discharge, >30 min | CPT 99239 | $252.80 |
| Basic metabolic panel (BMP) | CPT 80048 | $78.30 |
| General health panel | CPT 80050 | $42.66 |
| Electrolyte panel | CPT 80051 | $116.13 |
| Comprehensive metabolic panel | CPT 80053 | $243.60 |
| Lipid panel | CPT 80061 | $167.04 |
| Renal function panel | CPT 80069 | $216.46 |
| Hepatic function panel | CPT 80076 | $191.97 |
| Urinalysis non-automated | CPT 81002 | $31.60 |
| Urinalysis automated | CPT 81003 | $41.76 |
| Glucose quantitative | CPT 82947 | $78.30 |
| Hemoglobin A1c | CPT 83036 | $93.22 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $43.85 |
| Complete blood count with automated differential | CPT 85025 | $179.22 |
| Complete blood count without differential | CPT 85027 | $123.54 |
| Urine culture bacterial | CPT 87086 | $98.31 |
| Urine culture identification | CPT 87088 | $78.21 |
| Tissue exam by pathologist level IV | CPT 88305 | $122.37 |
| Fetal non-stress test | CPT 59025 | $109.02 |
| Vaginal delivery only | CPT 59409 | $1,677.96 |
| Vaginal delivery with postpartum | CPT 59410 | $2,271.25 |
| C-section delivery only | CPT 59514 | $1,884.15 |
| C-section with postpartum | CPT 59515 | $2,799.76 |
| Office visit, new patient, 15-29 min | CPT 99202 | $161.16 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $249.64 |
| Office visit, new patient, 45-59 min | CPT 99204 | $280.45 |
| Office visit, new patient, 60-74 min | CPT 99205 | $369.72 |
| Office visit, established patient, 5 min | CPT 99211 | $32.39 |
| Office visit, established patient, 10-19 min | CPT 99212 | $161.95 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $205.40 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $216.46 |
| Office visit, established patient, 40-54 min | CPT 99215 | $303.36 |
| Upper GI endoscopy diagnostic | CPT 43235 | $613.83 |
| Upper GI endoscopy with biopsy | CPT 43239 | $831.87 |
| Sigmoidoscopy diagnostic | CPT 45330 | $421.07 |
| Sigmoidoscopy with biopsy | CPT 45331 | $636.74 |
| Colonoscopy diagnostic | CPT 45378 | $756.03 |
| Colonoscopy with biopsy | CPT 45380 | $959.85 |
| Colonoscopy with polyp removal | CPT 45385 | $1,004.09 |
| Total shoulder arthroplasty | CPT 23472 | $74.50 |
| Total hip replacement | CPT 27130 | $74.50 |
| Total knee replacement | CPT 27447 | $74.50 |
| Open appendectomy | CPT 44950 | $1,376.18 |
| Laparoscopic appendectomy | CPT 44970 | $1,301.13 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,423.58 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $1,546.82 |
| Lap inguinal hernia repair | CPT 49650 | $944.05 |
| Total abdominal hysterectomy | CPT 58150 | $2,218.32 |
| Vaginal hysterectomy | CPT 58260 | $1,852.55 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $1,922.07 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $2,136.16 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,417.26 |
