| ED visit level 1 | CPT 99281 | $500.55 |
| ED visit level 2 | CPT 99282 | $1,001.1 |
| ED visit level 3 | CPT 99283 | $1,451.6 |
| ED visit level 4 | CPT 99284 | $2,820.61 |
| ED visit level 5 | CPT 99285 | $4,871.58 |
| Critical care, first hour | CPT 99291 | $4,778.74 |
| CT head without contrast | CPT 70450 | $1,183.81 |
| CT head with contrast | CPT 70460 | $1,621.79 |
| CT head with and without contrast | CPT 70470 | $1,941.31 |
| CT neck with contrast | CPT 70491 | $1,504.16 |
| MRI brain without contrast | CPT 70551 | $2,042.12 |
| MRI brain with contrast | CPT 70552 | $2,960.69 |
| MRI brain with and without contrast | CPT 70553 | $3,403.53 |
| Chest X-ray single view | CPT 71045 | $304.49 |
| Chest X-ray 2 views | CPT 71046 | $395.73 |
| Chest X-ray 3 views | CPT 71047 | $605.12 |
| CT chest without contrast | CPT 71250 | $752.5 |
| CT chest with contrast | CPT 71260 | $1,474.96 |
| CT chest with and without contrast | CPT 71270 | $1,666.84 |
| MRI chest without contrast | CPT 71550 | $1,344.54 |
| MRI chest with contrast | CPT 71551 | $935.45 |
| MRI chest with and without contrast | CPT 71552 | $2,147.56 |
| Lumbosacral spine X-ray | CPT 72100 | $508.07 |
| CT cervical spine without contrast | CPT 72125 | $1,323.96 |
| CT thoracic spine without contrast | CPT 72128 | $1,323.96 |
| CT lumbar spine without contrast | CPT 72131 | $1,897.09 |
| MRI cervical spine without contrast | CPT 72141 | $2,858.63 |
| MRI thoracic spine without contrast | CPT 72146 | $2,485.8 |
| MRI lumbar spine without contrast | CPT 72148 | $2,485.8 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,604.28 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,774.21 |
| MRI lumbar spine with contrast | CPT 72158 | $4,150.87 |
| CT pelvis without contrast | CPT 72192 | $1,061.17 |
| CT pelvis with contrast | CPT 72193 | $2,081.46 |
| Shoulder X-ray | CPT 73030 | $377.92 |
| Humerus X-ray | CPT 73060 | $259.46 |
| Hand X-ray 3 views | CPT 73130 | $377.09 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,543.16 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,247.03 |
| Knee X-ray 1-2 views | CPT 73560 | $271.14 |
| Ankle X-ray 3 views | CPT 73610 | $372.08 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,544 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $4,248.71 |
| CT abdomen without contrast | CPT 74150 | $1,615.95 |
| CT abdomen with contrast | CPT 74160 | $2,522.78 |
| CT abdomen with and without contrast | CPT 74170 | $2,877.34 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,246.64 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,390.4 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,941.84 |
| MRI abdomen without contrast | CPT 74181 | $1,179.07 |
| MRI abdomen with and without contrast | CPT 74183 | $3,015.52 |
| Abdominal ultrasound complete | CPT 76700 | $465.52 |
| Abdominal ultrasound limited | CPT 76705 | $1,942.36 |
| Retroperitoneal ultrasound complete | CPT 76770 | $724.13 |
| Obstetric ultrasound first trimester | CPT 76801 | $572.3 |
| Obstetric ultrasound after first trimester | CPT 76805 | $665.74 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $406.29 |
| Transvaginal ultrasound | CPT 76830 | $262.8 |
| Pelvic ultrasound complete | CPT 76856 | $743.32 |
| Scrotal ultrasound | CPT 76870 | $586.49 |
| Diagnostic mammography unilateral | CPT 77065 | $357.7 |
| Diagnostic mammography bilateral | CPT 77066 | $385.43 |
| Screening mammography bilateral | CPT 77067 | $344.96 |
| EKG tracing only | CPT 93005 | $429.98 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,845.34 |
| Transthoracic echocardiogram | CPT 93307 | $1,172.1 |
| Stress echocardiogram | CPT 93350 | $769.18 |
| Basic metabolic panel (BMP) | CPT 80048 | $8.28 |
| General health panel | CPT 80050 | $110.74 |
| Electrolyte panel | CPT 80051 | $147.67 |
| Comprehensive metabolic panel | CPT 80053 | $10.33 |
| Lipid panel | CPT 80061 | $55.86 |
| Renal function panel | CPT 80069 | $8.49 |
| Hepatic function panel | CPT 80076 | $245.27 |
| Urinalysis non-automated | CPT 81002 | $31.71 |
| Urinalysis automated | CPT 81003 | $14.7 |
| Glucose quantitative | CPT 82947 | $30.19 |
| Hemoglobin A1c | CPT 83036 | $9.5 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $16.43 |
| Complete blood count with automated differential | CPT 85025 | $112.63 |
| Complete blood count without differential | CPT 85027 | $85.94 |
| Urine culture bacterial | CPT 87086 | $93.44 |
| Tissue exam by pathologist level IV | CPT 88305 | $25 |
| Fetal non-stress test | CPT 59025 | $767.34 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $2,700.21 |
| Vaginal delivery only | CPT 59409 | $896.73 |
| Vaginal delivery with postpartum | CPT 59410 | $1,186.12 |
| Routine obstetric care with C-section | CPT 59510 | $2,966.39 |
| C-section delivery only | CPT 59514 | $1,009.47 |
| C-section with postpartum | CPT 59515 | $1,454.4 |
| Office visit, new patient, 15-29 min | CPT 99202 | $102.96 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $180.02 |
| Office visit, new patient, 45-59 min | CPT 99204 | $301.95 |
| Office visit, new patient, 60-74 min | CPT 99205 | $338.91 |
| Office visit, established patient, 5 min | CPT 99211 | $31 |
| Office visit, established patient, 10-19 min | CPT 99212 | $75.85 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $130.32 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $204.93 |
| Office visit, established patient, 40-54 min | CPT 99215 | $237.06 |
| Upper GI endoscopy diagnostic | CPT 43235 | $364 |
| Upper GI endoscopy with biopsy | CPT 43239 | $469.92 |
| Sigmoidoscopy diagnostic | CPT 45330 | $229.81 |
| Sigmoidoscopy with biopsy | CPT 45331 | $361.18 |
| Colonoscopy diagnostic | CPT 45378 | $413.44 |
| Colonoscopy with biopsy | CPT 45380 | $537.67 |
| Colonoscopy with polyp removal | CPT 45385 | $554.09 |
| Total shoulder arthroplasty | CPT 23472 | $1,665.35 |
| Hip hemiarthroplasty | CPT 27125 | $1,303.81 |
| Total hip replacement | CPT 27130 | $1,476.98 |
| Total knee replacement | CPT 27447 | $1,475.26 |
| Knee revision arthroplasty single component | CPT 27486 | $1,615.14 |
| Knee revision arthroplasty all components | CPT 27487 | $2,011.69 |
| Shoulder arthroscopy with decompression | CPT 29826 | $197.43 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,235.06 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $631.72 |
| ACL reconstruction | CPT 29888 | $1,129.72 |
| CABG single arterial graft | CPT 33533 | $2,085.09 |
| CABG 2 arterial grafts | CPT 33534 | $2,446.51 |
| CABG 3 arterial grafts | CPT 33535 | $2,723.87 |
| CABG 4+ arterial grafts | CPT 33536 | $2,930.92 |
| Open appendectomy | CPT 44950 | $730.16 |
| Laparoscopic appendectomy | CPT 44970 | $686.67 |
| Laparoscopic cholecystectomy | CPT 47562 | $751.44 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $817.52 |
| Open umbilical hernia repair | CPT 49560 | $839.43 |
| Umbilical hernia repair age 5+ | CPT 49585 | $513.15 |
| Lap inguinal hernia repair | CPT 49650 | $495.08 |
| Lap incisional hernia repair | CPT 49652 | $847.07 |
| Total abdominal hysterectomy | CPT 58150 | $1,163.04 |
| Vaginal hysterectomy | CPT 58260 | $968.07 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $1,016.78 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $1,130.32 |
| Lap salpingo-oophorectomy | CPT 58661 | $749.39 |
| Complex cataract surgery | CPT 66982 | $866.91 |
| Cataract surgery with lens implant | CPT 66984 | $633.25 |
| Intravitreal injection | CPT 67028 | $133.2 |
| Vitrectomy mechanical | CPT 67042 | $1,326.96 |
