| ED visit level 1 | CPT 99281 | $161.04 |
| ED visit level 2 | CPT 99282 | $161.04 |
| ED visit level 3 | CPT 99283 | $322.08 |
| ED visit level 4 | CPT 99284 | $644.16 |
| ED visit level 5 | CPT 99285 | $4,992.25 |
| Critical care, first hour | CPT 99291 | $288.07 |
| CT head without contrast | CPT 70450 | $115.74 |
| CT head with contrast | CPT 70460 | $165.34 |
| CT head with and without contrast | CPT 70470 | $198.4 |
| CT neck with contrast | CPT 70491 | $259.03 |
| MRI brain without contrast | CPT 70551 | $699.06 |
| MRI brain with contrast | CPT 70552 | $1,032.71 |
| MRI brain with and without contrast | CPT 70553 | $1,175.7 |
| Chest X-ray single view | CPT 71045 | $27.44 |
| Chest X-ray 2 views | CPT 71046 | $35.97 |
| Chest X-ray 3 views | CPT 71047 | $157.61 |
| CT chest without contrast | CPT 71250 | $198.4 |
| CT chest with contrast | CPT 71260 | $259.03 |
| CT chest with and without contrast | CPT 71270 | $319.65 |
| MRI chest without contrast | CPT 71550 | $1,525.23 |
| MRI chest with contrast | CPT 71551 | $1,668.22 |
| MRI chest with and without contrast | CPT 71552 | $2,081.31 |
| Lumbosacral spine X-ray | CPT 72100 | $42.79 |
| CT cervical spine without contrast | CPT 72125 | $203.92 |
| CT thoracic spine without contrast | CPT 72128 | $198.4 |
| CT lumbar spine without contrast | CPT 72131 | $198.4 |
| MRI cervical spine without contrast | CPT 72141 | $667.29 |
| MRI thoracic spine without contrast | CPT 72146 | $667.29 |
| MRI lumbar spine without contrast | CPT 72148 | $667.29 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,032.71 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,175.7 |
| MRI lumbar spine with contrast | CPT 72158 | $1,175.7 |
| CT pelvis without contrast | CPT 72192 | $143.29 |
| CT pelvis with contrast | CPT 72193 | $259.03 |
| Shoulder X-ray | CPT 73030 | $37.48 |
| Humerus X-ray | CPT 73060 | $34.29 |
| Hand X-ray 3 views | CPT 73130 | $40.02 |
| MRI upper extremity joint without contrast | CPT 73221 | $746.73 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,620.56 |
| Hip X-ray 2 views | CPT 73510 | $70.05 |
| Knee X-ray 1-2 views | CPT 73560 | $36.81 |
| Ankle X-ray 3 views | CPT 73610 | $39.3 |
| MRI lower extremity joint without contrast | CPT 73721 | $746.73 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,620.56 |
| CT abdomen without contrast | CPT 74150 | $137.78 |
| CT abdomen with contrast | CPT 74160 | $259.03 |
| CT abdomen with and without contrast | CPT 74170 | $297.61 |
| CT abdomen and pelvis without contrast | CPT 74176 | $176.36 |
| CT abdomen and pelvis with contrast | CPT 74177 | $341.7 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $391.3 |
| MRI abdomen without contrast | CPT 74181 | $1,159.81 |
| MRI abdomen with and without contrast | CPT 74183 | $1,763.55 |
| Abdominal ultrasound complete | CPT 76700 | $402.79 |
| Abdominal ultrasound limited | CPT 76705 | $315.23 |
| Retroperitoneal ultrasound complete | CPT 76770 | $385.28 |
| Obstetric ultrasound first trimester | CPT 76801 | $124.78 |
| Obstetric ultrasound after first trimester | CPT 76805 | $144.6 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $187.77 |
| Transvaginal ultrasound | CPT 76830 | $437.82 |
| Pelvic ultrasound complete | CPT 76856 | $367.77 |
| Scrotal ultrasound | CPT 76870 | $175.13 |
| Diagnostic mammography unilateral | CPT 77065 | $455.33 |
| Diagnostic mammography bilateral | CPT 77066 | $595.43 |
| Screening mammography bilateral | CPT 77067 | $490.36 |
| EKG complete | CPT 93000 | $15.26 |
| EKG tracing only | CPT 93005 | $32.62 |
| Transthoracic echocardiogram complete | CPT 93306 | $163.08 |
| Transthoracic echocardiogram | CPT 93307 | $262.69 |
| Stress echocardiogram | CPT 93350 | $163.08 |
| Initial hospital care, low complexity | CPT 99221 | $99.49 |
| Initial hospital care, moderate complexity | CPT 99222 | $143.3 |
| Initial hospital care, high complexity | CPT 99223 | $189.78 |
| Hospital discharge, <30 min | CPT 99238 | $84.43 |
| Hospital discharge, >30 min | CPT 99239 | $119.01 |
| Urinalysis non-automated | CPT 81002 | $3.08 |
| Glucose quantitative | CPT 82947 | $11.13 |
| Hemoglobin A1c | CPT 83036 | $11 |
| Fetal non-stress test | CPT 59025 | $1,030.91 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $2,626.52 |
| Vaginal delivery only | CPT 59409 | $863.89 |
| Vaginal delivery with postpartum | CPT 59410 | $1,169.97 |
| Routine obstetric care with C-section | CPT 59510 | $2,929.48 |
| C-section delivery only | CPT 59514 | $3,917.45 |
| C-section with postpartum | CPT 59515 | $1,457.61 |
| Office visit, new patient, 15-29 min | CPT 99202 | $76.69 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $118.35 |
| Office visit, new patient, 45-59 min | CPT 99204 | $176.96 |
| Office visit, new patient, 60-74 min | CPT 99205 | $233.33 |
| Office visit, established patient, 5 min | CPT 99211 | $24.85 |
| Office visit, established patient, 10-19 min | CPT 99212 | $60.11 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $96.22 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $135.52 |
| Office visit, established patient, 40-54 min | CPT 99215 | $190.78 |
| Upper GI endoscopy diagnostic | CPT 43235 | $307.64 |
| Upper GI endoscopy with biopsy | CPT 43239 | $402.46 |
| Sigmoidoscopy diagnostic | CPT 45330 | $199.89 |
| Sigmoidoscopy with biopsy | CPT 45331 | $306.84 |
| Colonoscopy diagnostic | CPT 45378 | $362.59 |
| Colonoscopy with biopsy | CPT 45380 | $462.64 |
| Colonoscopy with polyp removal | CPT 45385 | $483.5 |
| Total shoulder arthroplasty | CPT 23472 | $1,549.39 |
| Total hip replacement | CPT 27130 | $1,379.34 |
| Total knee replacement | CPT 27447 | $1,377.04 |
| Knee revision arthroplasty all components | CPT 27487 | $1,878.42 |
| Shoulder arthroscopy with decompression | CPT 29826 | $181.68 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,151.12 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $589.28 |
| ACL reconstruction | CPT 29888 | $1,049.4 |
| Laparoscopic appendectomy | CPT 44970 | $652.12 |
| Laparoscopic cholecystectomy | CPT 47562 | $714.89 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $776.96 |
| Lap inguinal hernia repair | CPT 49650 | $470.9 |
| Total abdominal hysterectomy | CPT 58150 | $1,087.72 |
| Vaginal hysterectomy | CPT 58260 | $899.13 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $1,049.12 |
| Lap salpingo-oophorectomy | CPT 58661 | $697.97 |
| Complex cataract surgery | CPT 66982 | $779.68 |
| Cataract surgery with lens implant | CPT 66984 | $569.21 |
| Intravitreal injection | CPT 67028 | $1,137.15 |
