| ED visit level 1 | CPT 99281 | $196.32 |
| ED visit level 2 | CPT 99282 | $301.16 |
| ED visit level 3 | CPT 99283 | $555.59 |
| ED visit level 4 | CPT 99284 | $1,102.73 |
| ED visit level 5 | CPT 99285 | $1,256.51 |
| Critical care, first hour | CPT 99291 | $2,286.18 |
| CT head without contrast | CPT 70450 | $692.22 |
| CT head with contrast | CPT 70460 | $829.71 |
| CT head with and without contrast | CPT 70470 | $1,035.91 |
| CT neck with contrast | CPT 70491 | $771.12 |
| MRI brain without contrast | CPT 70551 | $1,137.81 |
| MRI brain with and without contrast | CPT 70553 | $1,753.95 |
| Chest X-ray single view | CPT 71045 | $122.30 |
| Chest X-ray 2 views | CPT 71046 | $122.30 |
| Chest X-ray 3 views | CPT 71047 | $122.30 |
| CT chest without contrast | CPT 71250 | $865.44 |
| CT chest with contrast | CPT 71260 | $1,035.91 |
| CT chest with and without contrast | CPT 71270 | $1,291.89 |
| MRI chest without contrast | CPT 71550 | $869.55 |
| Lumbosacral spine X-ray | CPT 72100 | $164.73 |
| CT cervical spine without contrast | CPT 72125 | $865.44 |
| CT thoracic spine without contrast | CPT 72128 | $733.36 |
| CT lumbar spine without contrast | CPT 72131 | $865.44 |
| MRI cervical spine without contrast | CPT 72141 | $1,388.90 |
| MRI thoracic spine without contrast | CPT 72146 | $1,260.84 |
| MRI lumbar spine without contrast | CPT 72148 | $1,399.53 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,630.52 |
| MRI lumbar spine with contrast | CPT 72158 | $2,157.45 |
| CT pelvis without contrast | CPT 72192 | $856.22 |
| CT pelvis with contrast | CPT 72193 | $1,000.83 |
| Shoulder X-ray | CPT 73030 | $122.30 |
| Humerus X-ray | CPT 73060 | $122.30 |
| Hand X-ray 3 views | CPT 73130 | $122.30 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,246.17 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,017.02 |
| Knee X-ray 1-2 views | CPT 73560 | $122.30 |
| Ankle X-ray 3 views | CPT 73610 | $122.30 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,023.69 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,932.24 |
| CT abdomen without contrast | CPT 74150 | $829.71 |
| CT abdomen with contrast | CPT 74160 | $1,000.83 |
| CT abdomen with and without contrast | CPT 74170 | $1,240.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,529.26 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,731.65 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,101.50 |
| MRI abdomen without contrast | CPT 74181 | $1,388.90 |
| MRI abdomen with and without contrast | CPT 74183 | $2,191.35 |
| Abdominal ultrasound complete | CPT 76700 | $288.95 |
| Abdominal ultrasound limited | CPT 76705 | $208.31 |
| Obstetric ultrasound first trimester | CPT 76801 | $189.22 |
| Obstetric ultrasound after first trimester | CPT 76805 | $292.57 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $343.84 |
| Transvaginal ultrasound | CPT 76830 | $224.42 |
| Pelvic ultrasound complete | CPT 76856 | $224.42 |
| EKG tracing only | CPT 93005 | $152.75 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,558.73 |
| Basic metabolic panel (BMP) | CPT 80048 | $192.63 |
| Electrolyte panel | CPT 80051 | $34.01 |
| Comprehensive metabolic panel | CPT 80053 | $234.46 |
| Lipid panel | CPT 80061 | $148.44 |
| Renal function panel | CPT 80069 | $78.45 |
| Hepatic function panel | CPT 80076 | $155.77 |
| Urinalysis automated | CPT 81003 | $11.16 |
| Glucose quantitative | CPT 82947 | $27.76 |
| Hemoglobin A1c | CPT 83036 | $48.37 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $81.48 |
| Complete blood count with automated differential | CPT 85025 | $61.21 |
| Complete blood count without differential | CPT 85027 | $61.37 |
| Urine culture bacterial | CPT 87086 | $40.22 |
| Urine culture identification | CPT 87088 | $40.29 |
| Tissue exam by pathologist level IV | CPT 88305 | $251.53 |
| Office visit, new patient, 15-29 min | CPT 99202 | $193.14 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $267.26 |
| Office visit, new patient, 45-59 min | CPT 99204 | $334.99 |
| Office visit, established patient, 5 min | CPT 99211 | $161.44 |
| Office visit, established patient, 10-19 min | CPT 99212 | $193.14 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $230.28 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $267.26 |
| Office visit, established patient, 40-54 min | CPT 99215 | $334.99 |
| Upper GI endoscopy diagnostic | CPT 43235 | $778.83 |
| Upper GI endoscopy with biopsy | CPT 43239 | $778.83 |
| Sigmoidoscopy diagnostic | CPT 45330 | $778.03 |
| Sigmoidoscopy with biopsy | CPT 45331 | $763.48 |
| Colonoscopy diagnostic | CPT 45378 | $763.48 |
| Colonoscopy with biopsy | CPT 45380 | $997.54 |
| Colonoscopy with polyp removal | CPT 45385 | $997.54 |
| Total shoulder arthroplasty | CPT 23472 | $11,283 |
| Total hip replacement | CPT 27130 | $11,734 |
| Total knee replacement | CPT 27447 | $11,734 |
| Knee revision arthroplasty single component | CPT 27486 | $11,283 |
| Knee revision arthroplasty all components | CPT 27487 | $11,685 |
| Shoulder arthroscopy with decompression | CPT 29826 | $1,375.89 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $5,739.82 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $3,314.03 |
| ACL reconstruction | CPT 29888 | $5,739.82 |
| Laparoscopic appendectomy | CPT 44970 | $4,821.72 |
| Laparoscopic cholecystectomy | CPT 47562 | $4,868.09 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $4,960.81 |
| Open umbilical hernia repair | CPT 49560 | $3,062.41 |
| Umbilical hernia repair age 5+ | CPT 49585 | $3,062.41 |
| Lap inguinal hernia repair | CPT 49650 | $4,868.09 |
| Lap incisional hernia repair | CPT 49652 | $4,821.72 |
| Vaginal hysterectomy | CPT 58260 | $4,201.53 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $5,179.93 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $8,487.46 |
| Lap salpingo-oophorectomy | CPT 58661 | $4,868.09 |
| PCI single major coronary artery | CPT 92920 | $9,243.13 |
| PCI with drug-eluting stent | CPT 92928 | $10,870 |
| PCI bypass graft | CPT 92937 | $10,870 |
| Coronary angiography with cath | CPT 93455 | $2,841.95 |
| Coronary angiography with bypass cath | CPT 93458 | $5,181.69 |
