| Psychiatric diagnostic evaluation | CPT 90791 | $248.48 |
| Psychiatric eval with medical services | CPT 90792 | $307.38 |
| Psychotherapy 30 minutes | CPT 90832 | $133.15 |
| Psychotherapy 45 minutes | CPT 90834 | $244.43 |
| Psychotherapy 60 minutes | CPT 90837 | $248.48 |
| ED visit level 1 | CPT 99281 | $51.84 |
| ED visit level 2 | CPT 99282 | $85.49 |
| ED visit level 3 | CPT 99283 | $360.7 |
| ED visit level 4 | CPT 99284 | $568.14 |
| ED visit level 5 | CPT 99285 | $814.79 |
| Critical care, first hour | CPT 99291 | $397.99 |
| CT head without contrast | CPT 70450 | $562.35 |
| CT head with contrast | CPT 70460 | $471.96 |
| CT head with and without contrast | CPT 70470 | $678.96 |
| CT neck with contrast | CPT 70491 | $775.56 |
| MRI brain without contrast | CPT 70551 | $1,298.81 |
| MRI brain with contrast | CPT 70552 | $934.03 |
| MRI brain with and without contrast | CPT 70553 | $1,717.87 |
| Chest X-ray single view | CPT 71045 | $92.23 |
| Chest X-ray 2 views | CPT 71046 | $122.59 |
| CT chest without contrast | CPT 71250 | $1,187.95 |
| CT chest with contrast | CPT 71260 | $1,359.07 |
| CT chest with and without contrast | CPT 71270 | $1,816.31 |
| Lumbosacral spine X-ray | CPT 72100 | $223.56 |
| CT cervical spine without contrast | CPT 72125 | $790.74 |
| CT thoracic spine without contrast | CPT 72128 | $879.98 |
| CT lumbar spine without contrast | CPT 72131 | $943.23 |
| MRI cervical spine without contrast | CPT 72141 | $1,420.25 |
| MRI thoracic spine without contrast | CPT 72146 | $1,420.25 |
| MRI lumbar spine without contrast | CPT 72148 | $1,420.25 |
| MRI lumbar spine with and without contrast | CPT 72149 | $934.03 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,656.23 |
| MRI lumbar spine with contrast | CPT 72158 | $1,656.23 |
| CT pelvis without contrast | CPT 72192 | $575 |
| CT pelvis with contrast | CPT 72193 | $613.41 |
| Shoulder X-ray | CPT 73030 | $155.02 |
| Humerus X-ray | CPT 73060 | $164.45 |
| Hand X-ray 3 views | CPT 73130 | $155.48 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,251.89 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $949.44 |
| Knee X-ray 1-2 views | CPT 73560 | $188.6 |
| Ankle X-ray 3 views | CPT 73610 | $142.6 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,257.18 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $949.44 |
| CT abdomen without contrast | CPT 74150 | $848.47 |
| CT abdomen with contrast | CPT 74160 | $1,558.94 |
| CT abdomen with and without contrast | CPT 74170 | $1,793.08 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,234.64 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,954.54 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,769.89 |
| MRI abdomen without contrast | CPT 74181 | $683.56 |
| MRI abdomen with and without contrast | CPT 74183 | $1,540.08 |
| Abdominal ultrasound complete | CPT 76700 | $385.02 |
| Abdominal ultrasound limited | CPT 76705 | $356.73 |
| Retroperitoneal ultrasound complete | CPT 76770 | $262.89 |
| Obstetric ultrasound first trimester | CPT 76801 | $124.66 |
| Obstetric ultrasound after first trimester | CPT 76805 | $124.66 |
| Transvaginal ultrasound | CPT 76830 | $300.84 |
| Pelvic ultrasound complete | CPT 76856 | $443.44 |
| Scrotal ultrasound | CPT 76870 | $351.9 |
| Diagnostic mammography unilateral | CPT 77065 | $129.26 |
| Diagnostic mammography bilateral | CPT 77066 | $163.76 |
| Screening mammography bilateral | CPT 77067 | $110.4 |
| EKG complete | CPT 93000 | $45.13 |
| EKG tracing only | CPT 93005 | $115.25 |
| EKG interpretation only | CPT 93010 | $21.05 |
| Transthoracic echocardiogram complete | CPT 93306 | $681 |
| Initial hospital care, low complexity | CPT 99221 | $207.17 |
| Initial hospital care, moderate complexity | CPT 99222 | $279.61 |
| Initial hospital care, high complexity | CPT 99223 | $412.89 |
| Hospital discharge, <30 min | CPT 99238 | $149.22 |
| Hospital discharge, >30 min | CPT 99239 | $218.77 |
| Basic metabolic panel (BMP) | CPT 80048 | $42.55 |
| General health panel | CPT 80050 | $155.48 |
| Electrolyte panel | CPT 80051 | $21.62 |
| Comprehensive metabolic panel | CPT 80053 | $64.17 |
| Lipid panel | CPT 80061 | $32.89 |
| Renal function panel | CPT 80069 | $48.53 |
| Hepatic function panel | CPT 80076 | $42.55 |
| Urinalysis non-automated | CPT 81002 | $38.16 |
| Glucose quantitative | CPT 82947 | $40.67 |
| Hemoglobin A1c | CPT 83036 | $26.45 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $48.53 |
| Complete blood count with automated differential | CPT 85025 | $30.36 |
| Complete blood count without differential | CPT 85027 | $28.98 |
| Urine culture bacterial | CPT 87086 | $34.27 |
| Tissue exam by pathologist level IV | CPT 88305 | $172.04 |
| Fetal non-stress test | CPT 59025 | $138.92 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $3,136.09 |
| Vaginal delivery only | CPT 59409 | $1,870.6 |
| Vaginal delivery with postpartum | CPT 59410 | $1,553.77 |
| Routine obstetric care with C-section | CPT 59510 | $3,477.05 |
| C-section delivery only | CPT 59514 | $1,366.43 |
| C-section with postpartum | CPT 59515 | $1,889.02 |
| Office visit, new patient, 15-29 min | CPT 99202 | $142.68 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $142.68 |
| Office visit, new patient, 45-59 min | CPT 99204 | $368.39 |
| Office visit, new patient, 60-74 min | CPT 99205 | $479.09 |
| Office visit, established patient, 5 min | CPT 99211 | $25.83 |
| Office visit, established patient, 10-19 min | CPT 99212 | $21.76 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $183.27 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $183.27 |
| Office visit, established patient, 40-54 min | CPT 99215 | $183.27 |
| Upper GI endoscopy diagnostic | CPT 43235 | $220.9 |
| Upper GI endoscopy with biopsy | CPT 43239 | $247.69 |
| Sigmoidoscopy diagnostic | CPT 45330 | $142.93 |
| Sigmoidoscopy with biopsy | CPT 45331 | $125.49 |
| Colonoscopy diagnostic | CPT 45378 | $360.49 |
| Colonoscopy with biopsy | CPT 45380 | $430.52 |
| Colonoscopy with polyp removal | CPT 45385 | $512.3 |
| Total shoulder arthroplasty | CPT 23472 | $2,176.01 |
| Hip hemiarthroplasty | CPT 27125 | $1,697.53 |
| Total hip replacement | CPT 27130 | $2,255.53 |
| Total knee replacement | CPT 27447 | $2,279.99 |
| Shoulder arthroscopy with decompression | CPT 29826 | $259.79 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,777.07 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $891.12 |
| ACL reconstruction | CPT 29888 | $1,642.18 |
| Open appendectomy | CPT 44950 | $1,061.26 |
| Laparoscopic appendectomy | CPT 44970 | $988.41 |
| Laparoscopic cholecystectomy | CPT 47562 | $1,083.82 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $1,193.8 |
| Lap inguinal hernia repair | CPT 49650 | $703.12 |
| Total abdominal hysterectomy | CPT 58150 | $1,510.19 |
| Vaginal hysterectomy | CPT 58260 | $1,397.31 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $1,509.98 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $1,679.65 |
| Lap salpingo-oophorectomy | CPT 58661 | $1,090.87 |
