| ED visit level 1 | CPT 99281 | $73.64 |
| ED visit level 2 | CPT 99282 | $133.47 |
| ED visit level 3 | CPT 99283 | $230.39 |
| ED visit level 4 | CPT 99284 | $401.36 |
| ED visit level 5 | CPT 99285 | $159.28 |
| Critical care, first hour | CPT 99291 | $1,378.5 |
| CT head without contrast | CPT 70450 | $665 |
| CT head with contrast | CPT 70460 | $805 |
| CT head with and without contrast | CPT 70470 | $1,332 |
| CT neck with contrast | CPT 70491 | $884 |
| MRI brain without contrast | CPT 70551 | $1,921.87 |
| MRI brain with contrast | CPT 70552 | $1,577.66 |
| MRI brain with and without contrast | CPT 70553 | $1,774.64 |
| Chest X-ray single view | CPT 71045 | $84.39 |
| Chest X-ray 2 views | CPT 71046 | $79.84 |
| Chest X-ray 3 views | CPT 71047 | $166 |
| CT chest without contrast | CPT 71250 | $660.73 |
| CT chest with contrast | CPT 71260 | $774.5 |
| CT chest with and without contrast | CPT 71270 | $853 |
| MRI chest without contrast | CPT 71550 | $383.53 |
| MRI chest with contrast | CPT 71551 | $743.88 |
| MRI chest with and without contrast | CPT 71552 | $892.9 |
| Lumbosacral spine X-ray | CPT 72100 | $51.74 |
| CT cervical spine without contrast | CPT 72125 | $1,162.5 |
| CT thoracic spine without contrast | CPT 72128 | $622 |
| CT lumbar spine without contrast | CPT 72131 | $956.5 |
| MRI cervical spine without contrast | CPT 72141 | $1,728.68 |
| MRI thoracic spine without contrast | CPT 72146 | $1,728.68 |
| MRI lumbar spine without contrast | CPT 72148 | $1,728.68 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,577.66 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,696.19 |
| MRI lumbar spine with contrast | CPT 72158 | $1,643.02 |
| CT pelvis without contrast | CPT 72192 | $576.75 |
| CT pelvis with contrast | CPT 72193 | $743.28 |
| Shoulder X-ray | CPT 73030 | $51.78 |
| Humerus X-ray | CPT 73060 | $48.96 |
| Hand X-ray 3 views | CPT 73130 | $48.96 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,284.45 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,662.32 |
| Hip X-ray 2 views | CPT 73510 | $39.14 |
| Knee X-ray 1-2 views | CPT 73560 | $45.38 |
| Ankle X-ray 3 views | CPT 73610 | $48.96 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,363.02 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $908.75 |
| CT abdomen without contrast | CPT 74150 | $692 |
| CT abdomen with contrast | CPT 74160 | $861.56 |
| CT abdomen with and without contrast | CPT 74170 | $1,075.12 |
| CT abdomen and pelvis without contrast | CPT 74176 | $579.76 |
| CT abdomen and pelvis with contrast | CPT 74177 | $887.46 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,059.3 |
| MRI abdomen without contrast | CPT 74181 | $1,360.11 |
| MRI abdomen with and without contrast | CPT 74183 | $1,541.51 |
| Abdominal ultrasound complete | CPT 76700 | $621.52 |
| Abdominal ultrasound limited | CPT 76705 | $183.48 |
| Retroperitoneal ultrasound complete | CPT 76770 | $226.17 |
| Obstetric ultrasound first trimester | CPT 76801 | $458.19 |
| Obstetric ultrasound after first trimester | CPT 76805 | $458.19 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $716 |
| Transvaginal ultrasound | CPT 76830 | $135.07 |
| Pelvic ultrasound complete | CPT 76856 | $204.51 |
| Scrotal ultrasound | CPT 76870 | $757.41 |
| Diagnostic mammography unilateral | CPT 77065 | $293.66 |
| Diagnostic mammography bilateral | CPT 77066 | $375.46 |
| Screening mammography bilateral | CPT 77067 | $254.1 |
| EKG complete | CPT 93000 | $29.64 |
| EKG tracing only | CPT 93005 | $28.3 |
| Transthoracic echocardiogram complete | CPT 93306 | $714.45 |
| Transthoracic echocardiogram | CPT 93307 | $303.81 |
| Stress echocardiogram | CPT 93350 | $334.39 |
| Basic metabolic panel (BMP) | CPT 80048 | $16.51 |
| General health panel | CPT 80050 | $69.16 |
| Electrolyte panel | CPT 80051 | $13.66 |
| Comprehensive metabolic panel | CPT 80053 | $27.33 |
| Lipid panel | CPT 80061 | $23.3 |
| Renal function panel | CPT 80069 | $19.36 |
| Hepatic function panel | CPT 80076 | $20.5 |
| Urinalysis non-automated | CPT 81002 | $4.98 |
| Urinalysis automated | CPT 81003 | $4.25 |
| Glucose quantitative | CPT 82947 | $12.72 |
| Hemoglobin A1c | CPT 83036 | $13.49 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $50.89 |
| Complete blood count with automated differential | CPT 85025 | $29.96 |
| Complete blood count without differential | CPT 85027 | $16.32 |
| Urine culture bacterial | CPT 87086 | $36.62 |
| Urine culture identification | CPT 87088 | $28.54 |
| Tissue exam by pathologist level IV | CPT 88305 | $112.71 |
| Fetal non-stress test | CPT 59025 | $293.31 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $4,749.77 |
| Office visit, new patient, 15-29 min | CPT 99202 | $102.51 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $130.29 |
| Office visit, new patient, 45-59 min | CPT 99204 | $188.34 |
| Office visit, new patient, 60-74 min | CPT 99205 | $228.48 |
| Office visit, established patient, 5 min | CPT 99211 | $61.13 |
| Office visit, established patient, 10-19 min | CPT 99212 | $81.51 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $103.12 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $130.29 |
| Office visit, established patient, 40-54 min | CPT 99215 | $171.67 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,242.91 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,355.9 |
| Sigmoidoscopy diagnostic | CPT 45330 | $490.91 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,051.19 |
| Colonoscopy diagnostic | CPT 45378 | $882.75 |
| Colonoscopy with biopsy | CPT 45380 | $1,921.17 |
| Colonoscopy with polyp removal | CPT 45385 | $1,453.57 |
| Total hip replacement | CPT 27130 | $23,191 |
| Total knee replacement | CPT 27447 | $19,349 |
| Knee revision arthroplasty single component | CPT 27486 | $12,491 |
| Knee revision arthroplasty all components | CPT 27487 | $32,211 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $12,483 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $7,787.72 |
| ACL reconstruction | CPT 29888 | $16,587 |
| Open appendectomy | CPT 44950 | $10,544 |
| Laparoscopic appendectomy | CPT 44970 | $13,861 |
| Laparoscopic cholecystectomy | CPT 47562 | $12,899 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $10,303 |
| Open umbilical hernia repair | CPT 49560 | $6,789.42 |
| Umbilical hernia repair age 5+ | CPT 49585 | $7,584.43 |
| Lap inguinal hernia repair | CPT 49650 | $10,332 |
| Lap incisional hernia repair | CPT 49652 | $11,718 |
| Total abdominal hysterectomy | CPT 58150 | $17,852 |
| Vaginal hysterectomy | CPT 58260 | $10,560 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $11,911 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $13,860 |
| Lap salpingo-oophorectomy | CPT 58661 | $9,202.92 |
| Complex cataract surgery | CPT 66982 | $5,041.1 |
| Cataract surgery with lens implant | CPT 66984 | $4,805 |
| PCI single major coronary artery | CPT 92920 | $4,035.45 |
| PCI with drug-eluting stent | CPT 92928 | $7,874 |
| PCI bypass graft | CPT 92937 | $7,874 |
| Left heart catheterization | CPT 93452 | $3,206 |
| Coronary angiography with cath | CPT 93455 | $3,206 |
| Coronary angiography with bypass cath | CPT 93458 | $800 |
