| ED visit level 1 | CPT 99281 | $102.00 |
| ED visit level 2 | CPT 99282 | $171.00 |
| ED visit level 3 | CPT 99283 | $232.50 |
| ED visit level 4 | CPT 99284 | $390.00 |
| ED visit level 5 | CPT 99285 | $675.00 |
| Critical care, first hour | CPT 99291 | $1,089.00 |
| EKG complete | CPT 93000 | $85.50 |
| EKG tracing only | CPT 93005 | $90.00 |
| EKG interpretation only | CPT 93010 | $79.56 |
| Initial hospital care, low complexity | CPT 99221 | $274.50 |
| Initial hospital care, moderate complexity | CPT 99222 | $378.00 |
| Initial hospital care, high complexity | CPT 99223 | $454.50 |
| Hospital discharge, <30 min | CPT 99238 | $198.00 |
| Hospital discharge, >30 min | CPT 99239 | $279.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $90.00 |
| General health panel | CPT 80050 | $130.00 |
| Electrolyte panel | CPT 80051 | $90.00 |
| Comprehensive metabolic panel | CPT 80053 | $104.00 |
| Lipid panel | CPT 80061 | $90.00 |
| Renal function panel | CPT 80069 | $122.20 |
| Hepatic function panel | CPT 80076 | $90.00 |
| Urinalysis automated | CPT 81003 | $37.44 |
| Glucose quantitative | CPT 82947 | $34.21 |
| Hemoglobin A1c | CPT 83036 | $87.36 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $91.00 |
| Complete blood count with automated differential | CPT 85025 | $76.44 |
| Complete blood count without differential | CPT 85027 | $75.00 |
| Urine culture bacterial | CPT 87086 | $80.08 |
| Urine culture identification | CPT 87088 | $87.36 |
| Office visit, new patient, 15-29 min | CPT 99202 | $69.30 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $198.90 |
| Office visit, new patient, 45-59 min | CPT 99204 | $129.60 |
| Office visit, new patient, 60-74 min | CPT 99205 | $154.35 |
| Office visit, established patient, 5 min | CPT 99211 | $90.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $33.08 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $84.60 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $69.30 |
| Office visit, established patient, 40-54 min | CPT 99215 | $94.50 |
| Upper GI endoscopy diagnostic | CPT 43235 | $945.00 |
| Upper GI endoscopy with biopsy | CPT 43239 | $990.00 |
| Sigmoidoscopy diagnostic | CPT 45330 | $405.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | $648.00 |
| Colonoscopy diagnostic | CPT 45378 | $1,170.00 |
| Colonoscopy with biopsy | CPT 45380 | $1,170.00 |
| Colonoscopy with polyp removal | CPT 45385 | $1,620.00 |
| Open appendectomy | CPT 44950 | $2,520.00 |
| Laparoscopic appendectomy | CPT 44970 | $2,700.00 |
| Laparoscopic cholecystectomy | CPT 47562 | $2,250.00 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $3,168.00 |
| Open umbilical hernia repair | CPT 49560 | $2,898.00 |
| Umbilical hernia repair age 5+ | CPT 49585 | $1,728.00 |
| Lap inguinal hernia repair | CPT 49650 | $1,620.00 |
| Lap incisional hernia repair | CPT 49652 | $2,790.00 |
| Total abdominal hysterectomy | CPT 58150 | $3,690.00 |
| Lap salpingo-oophorectomy | CPT 58661 | $2,250.00 |
