| Psychiatric diagnostic evaluation | CPT 90791 | $205.5 |
| Psychiatric eval with medical services | CPT 90792 | $205.5 |
| Psychotherapy 30 minutes | CPT 90832 | $198 |
| Psychotherapy 45 minutes | CPT 90834 | $198 |
| Psychotherapy 60 minutes | CPT 90837 | $198 |
| ED visit level 1 | CPT 99281 | $294 |
| ED visit level 2 | CPT 99282 | $312 |
| ED visit level 3 | CPT 99283 | $595.5 |
| ED visit level 4 | CPT 99284 | $1,001 |
| ED visit level 5 | CPT 99285 | $1,477.5 |
| Critical care, first hour | CPT 99291 | $1,144.5 |
| CT head without contrast | CPT 70450 | $399 |
| CT head with contrast | CPT 70460 | $722.5 |
| CT head with and without contrast | CPT 70470 | $808.5 |
| CT neck with contrast | CPT 70491 | $722.5 |
| MRI brain without contrast | CPT 70551 | $348.5 |
| MRI brain with contrast | CPT 70552 | $431 |
| MRI brain with and without contrast | CPT 70553 | $684.5 |
| Chest X-ray single view | CPT 71045 | $104 |
| Chest X-ray 2 views | CPT 71046 | $104 |
| Chest X-ray 3 views | CPT 71047 | $104 |
| CT chest without contrast | CPT 71250 | $399 |
| CT chest with contrast | CPT 71260 | $722.5 |
| CT chest with and without contrast | CPT 71270 | $808.5 |
| MRI chest without contrast | CPT 71550 | $348.5 |
| MRI chest with contrast | CPT 71551 | $1,051.5 |
| MRI chest with and without contrast | CPT 71552 | $684.5 |
| Lumbosacral spine X-ray | CPT 72100 | $171.5 |
| CT cervical spine without contrast | CPT 72125 | $399 |
| CT thoracic spine without contrast | CPT 72128 | $399 |
| CT lumbar spine without contrast | CPT 72131 | $399 |
| MRI cervical spine without contrast | CPT 72141 | $348.5 |
| MRI thoracic spine without contrast | CPT 72146 | $348.5 |
| MRI lumbar spine without contrast | CPT 72148 | $348.5 |
| MRI lumbar spine with and without contrast | CPT 72149 | $684.5 |
| MRI cervical spine with and without contrast | CPT 72156 | $684.5 |
| MRI lumbar spine with contrast | CPT 72158 | $684.5 |
| CT pelvis without contrast | CPT 72192 | $399 |
| CT pelvis with contrast | CPT 72193 | $722.5 |
| Shoulder X-ray | CPT 73030 | $285 |
| Humerus X-ray | CPT 73060 | $104 |
| Hand X-ray 3 views | CPT 73130 | $156 |
| MRI upper extremity joint without contrast | CPT 73221 | $348.5 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $684.5 |
| Knee X-ray 1-2 views | CPT 73560 | $104 |
| Ankle X-ray 3 views | CPT 73610 | $104 |
| MRI lower extremity joint without contrast | CPT 73721 | $581 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $684.5 |
| CT abdomen without contrast | CPT 74150 | $399 |
| CT abdomen with contrast | CPT 74160 | $722.5 |
| CT abdomen with and without contrast | CPT 74170 | $808.5 |
| CT abdomen and pelvis without contrast | CPT 74176 | $710.5 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,126.5 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,126.5 |
| MRI abdomen without contrast | CPT 74181 | $348.5 |
| MRI abdomen with and without contrast | CPT 74183 | $684.5 |
| Abdominal ultrasound complete | CPT 76700 | $171.5 |
| Abdominal ultrasound limited | CPT 76705 | $171.5 |
| Retroperitoneal ultrasound complete | CPT 76770 | $171.5 |
| Obstetric ultrasound first trimester | CPT 76801 | $171.5 |
| Obstetric ultrasound after first trimester | CPT 76805 | $171.5 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $228 |
| Transvaginal ultrasound | CPT 76830 | $171.5 |
| Pelvic ultrasound complete | CPT 76856 | $171.5 |
| Scrotal ultrasound | CPT 76870 | $171.5 |
| EKG tracing only | CPT 93005 | $140 |
| EKG interpretation only | CPT 93010 | $80 |
| Transthoracic echocardiogram complete | CPT 93306 | $742 |
| Transthoracic echocardiogram | CPT 93307 | $730 |
| Basic metabolic panel (BMP) | CPT 80048 | $11.5 |
| Electrolyte panel | CPT 80051 | $34 |
| Comprehensive metabolic panel | CPT 80053 | $46 |
| Lipid panel | CPT 80061 | $65 |
| Renal function panel | CPT 80069 | $12 |
| Hepatic function panel | CPT 80076 | $40 |
| Urinalysis non-automated | CPT 81002 | $13 |
| Urinalysis automated | CPT 81003 | $14 |
| Glucose quantitative | CPT 82947 | $2 |
| Hemoglobin A1c | CPT 83036 | — |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $69 |
| Complete blood count with automated differential | CPT 85025 | $34 |
| Complete blood count without differential | CPT 85027 | $31 |
| Urine culture identification | CPT 87088 | $39 |
| Tissue exam by pathologist level IV | CPT 88305 | $112 |
| Office visit, new patient, 15-29 min | CPT 99202 | $545 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $728.5 |
| Office visit, new patient, 45-59 min | CPT 99204 | $709 |
| Office visit, new patient, 60-74 min | CPT 99205 | $823.5 |
| Office visit, established patient, 5 min | CPT 99211 | $545 |
| Office visit, established patient, 10-19 min | CPT 99212 | $545 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $635 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $726 |
| Office visit, established patient, 40-54 min | CPT 99215 | $545 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,416 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,416 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,133.5 |
| Colonoscopy diagnostic | CPT 45378 | $2,308 |
| Colonoscopy with biopsy | CPT 45380 | $3,681.5 |
| Colonoscopy with polyp removal | CPT 45385 | $3,043 |
| Total knee replacement | CPT 27447 | $12,198 |
| Shoulder arthroscopy with decompression | CPT 29826 | $32,619 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $6,613 |
| ACL reconstruction | CPT 29888 | $6,631 |
| Laparoscopic appendectomy | CPT 44970 | $6,201 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $191,510 |
| Major joint replacement w/o MCC | MS-DRG 470 | $98,725 |
| Laparoscopic cholecystectomy | CPT 47562 | $12,403 |
| Open umbilical hernia repair | CPT 49560 | $7,278 |
| Umbilical hernia repair age 5+ | CPT 49585 | $7,278 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $9,540 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG 743 | $47,206 |
