| ED visit level 1 | CPT 99281 | $122.83 |
| ED visit level 2 | CPT 99282 | $154.35 |
| ED visit level 3 | CPT 99283 | $315.74 |
| ED visit level 4 | CPT 99284 | $496.44 |
| ED visit level 5 | CPT 99285 | $781.67 |
| Critical care, first hour | CPT 99291 | $1,203.30 |
| CT head without contrast | CPT 70450 | $978.11 |
| CT head with contrast | CPT 70460 | $1,017.01 |
| CT head with and without contrast | CPT 70470 | $1,076.19 |
| CT neck with contrast | CPT 70491 | $1,017.01 |
| MRI brain without contrast | CPT 70551 | $1,485.80 |
| MRI brain with contrast | CPT 70552 | $1,584.06 |
| MRI brain with and without contrast | CPT 70553 | $2,759.00 |
| Chest X-ray single view | CPT 71045 | $107.21 |
| Chest X-ray 2 views | CPT 71046 | $79.69 |
| Chest X-ray 3 views | CPT 71047 | $121.84 |
| CT chest without contrast | CPT 71250 | $975.82 |
| CT chest with contrast | CPT 71260 | $1,017.01 |
| CT chest with and without contrast | CPT 71270 | $1,076.19 |
| MRI chest without contrast | CPT 71550 | $1,056.45 |
| MRI chest with contrast | CPT 71551 | $1,262.20 |
| MRI chest with and without contrast | CPT 71552 | $1,348.83 |
| Lumbosacral spine X-ray | CPT 72100 | $49.98 |
| CT cervical spine without contrast | CPT 72125 | $975.82 |
| CT thoracic spine without contrast | CPT 72128 | $848.54 |
| CT lumbar spine without contrast | CPT 72131 | $975.82 |
| MRI cervical spine without contrast | CPT 72141 | $1,451.42 |
| MRI thoracic spine without contrast | CPT 72146 | $1,451.42 |
| MRI lumbar spine without contrast | CPT 72148 | $1,518.07 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,518.07 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,749.25 |
| MRI lumbar spine with contrast | CPT 72158 | $2,749.25 |
| CT pelvis without contrast | CPT 72192 | $975.82 |
| CT pelvis with contrast | CPT 72193 | $1,017.01 |
| Shoulder X-ray | CPT 73030 | $49.98 |
| Humerus X-ray | CPT 73060 | $49.98 |
| Hand X-ray 3 views | CPT 73130 | $49.98 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,412.47 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,342.47 |
| Hip X-ray 2 views | CPT 73510 | $101.12 |
| Knee X-ray 1-2 views | CPT 73560 | $49.98 |
| Ankle X-ray 3 views | CPT 73610 | $49.98 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,412.47 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,712.58 |
| CT abdomen without contrast | CPT 74150 | $975.82 |
| CT abdomen with contrast | CPT 74160 | $1,017.01 |
| CT abdomen with and without contrast | CPT 74170 | $1,076.19 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,072.46 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,340.58 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,405.32 |
| MRI abdomen without contrast | CPT 74181 | $1,518.07 |
| MRI abdomen with and without contrast | CPT 74183 | $2,759.00 |
| Abdominal ultrasound complete | CPT 76700 | $105.98 |
| Abdominal ultrasound limited | CPT 76705 | $192.28 |
| Retroperitoneal ultrasound complete | CPT 76770 | $276.13 |
| Obstetric ultrasound first trimester | CPT 76801 | $284.21 |
| Obstetric ultrasound after first trimester | CPT 76805 | $270.71 |
| Transvaginal ultrasound | CPT 76830 | $253.76 |
| Pelvic ultrasound complete | CPT 76856 | $260.82 |
| Scrotal ultrasound | CPT 76870 | $213.88 |
| Diagnostic mammography unilateral | CPT 77065 | $274.24 |
| Diagnostic mammography bilateral | CPT 77066 | $338.88 |
| Screening mammography bilateral | CPT 77067 | $221.68 |
| EKG tracing only | CPT 93005 | $54.28 |
| Transthoracic echocardiogram complete | CPT 93306 | $766.65 |
| Transthoracic echocardiogram | CPT 93307 | $478.01 |
| Stress echocardiogram | CPT 93350 | $556.34 |
| Basic metabolic panel (BMP) | CPT 80048 | $141.25 |
| Electrolyte panel | CPT 80051 | $71.26 |
| Comprehensive metabolic panel | CPT 80053 | $250.57 |
| Lipid panel | CPT 80061 | $51.06 |
| Renal function panel | CPT 80069 | $176.88 |
| Hepatic function panel | CPT 80076 | $123.44 |
| Urinalysis non-automated | CPT 81002 | $5.90 |
| Urinalysis automated | CPT 81003 | $26.27 |
| Glucose quantitative | CPT 82947 | $6.11 |
| Hemoglobin A1c | CPT 83036 | $15.80 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $75.02 |
| Complete blood count with automated differential | CPT 85025 | $23.94 |
| Complete blood count without differential | CPT 85027 | $15.10 |
| Urine culture bacterial | CPT 87086 | $19.15 |
| Tissue exam by pathologist level IV | CPT 88305 | $131.20 |
| Fetal non-stress test | CPT 59025 | $137.51 |
| Vaginal delivery only | CPT 59409 | $3,864.56 |
| C-section delivery only | CPT 59514 | $5,735.94 |
| Office visit, new patient, 15-29 min | CPT 99202 | $113.77 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $97.72 |
| Office visit, new patient, 45-59 min | CPT 99204 | $106.79 |
| Office visit, new patient, 60-74 min | CPT 99205 | $113.77 |
| Office visit, established patient, 5 min | CPT 99211 | $83.06 |
| Office visit, established patient, 10-19 min | CPT 99212 | $126.33 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $131.92 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $106.79 |
| Office visit, established patient, 40-54 min | CPT 99215 | $202.41 |
| Upper GI endoscopy diagnostic | CPT 43235 | $835.45 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,847.84 |
| Sigmoidoscopy diagnostic | CPT 45330 | $409.90 |
| Sigmoidoscopy with biopsy | CPT 45331 | $825.93 |
| Colonoscopy diagnostic | CPT 45378 | $773.57 |
| Colonoscopy with biopsy | CPT 45380 | $976.29 |
| Colonoscopy with polyp removal | CPT 45385 | $1,553.40 |
| Total shoulder arthroplasty | CPT 23472 | $21,004 |
| Total hip replacement | CPT 27130 | $18,076 |
| Total knee replacement | CPT 27447 | $17,808 |
| Knee revision arthroplasty single component | CPT 27486 | $11,539 |
| Knee revision arthroplasty all components | CPT 27487 | $24,066 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $17,918 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $5,389.25 |
| ACL reconstruction | CPT 29888 | $12,215 |
| Open appendectomy | CPT 44950 | $15,375 |
| Laparoscopic appendectomy | CPT 44970 | $10,987 |
| Laparoscopic cholecystectomy | CPT 47562 | $7,476.49 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $12,766 |
| Open umbilical hernia repair | CPT 49560 | $5,201.44 |
| Umbilical hernia repair age 5+ | CPT 49585 | $6,294.82 |
| Lap inguinal hernia repair | CPT 49650 | $9,376.82 |
| Lap incisional hernia repair | CPT 49652 | $11,830 |
| Lap salpingo-oophorectomy | CPT 58661 | $7,130.56 |
| Left heart catheterization | CPT 93452 | $3,893.72 |
| Coronary angiography with cath | CPT 93455 | $3,826.65 |
| Coronary angiography with bypass cath | CPT 93458 | $3,826.65 |
