| ED visit level 1 | CPT 99281 | $11.56 |
| ED visit level 2 | CPT 99282 | $40.98 |
| ED visit level 3 | CPT 99283 | $69.82 |
| ED visit level 4 | CPT 99284 | $118.34 |
| ED visit level 5 | CPT 99285 | $171.81 |
| Critical care, first hour | CPT 99291 | $256.36 |
| CT head without contrast | CPT 70450 | $702.4 |
| CT head with contrast | CPT 70460 | $902.72 |
| CT head with and without contrast | CPT 70470 | $1,167.36 |
| CT neck with contrast | CPT 70491 | $871.68 |
| MRI brain without contrast | CPT 70551 | $103.68 |
| MRI brain with contrast | CPT 70552 | $1,361.92 |
| MRI brain with and without contrast | CPT 70553 | $1,790.72 |
| Chest X-ray single view | CPT 71045 | $58.88 |
| Chest X-ray 2 views | CPT 71046 | $146.56 |
| Chest X-ray 3 views | CPT 71047 | $146.56 |
| CT chest without contrast | CPT 71250 | $663.04 |
| CT chest with contrast | CPT 71260 | $866.56 |
| CT chest with and without contrast | CPT 71270 | $932.48 |
| MRI chest without contrast | CPT 71550 | $1,547.52 |
| MRI chest with contrast | CPT 71551 | $1,695.36 |
| MRI chest with and without contrast | CPT 71552 | $2,007.04 |
| Lumbosacral spine X-ray | CPT 72100 | $100.48 |
| CT cervical spine without contrast | CPT 72125 | $738.24 |
| CT thoracic spine without contrast | CPT 72128 | $754.24 |
| CT lumbar spine without contrast | CPT 72131 | $721.28 |
| MRI cervical spine without contrast | CPT 72141 | $1,173.12 |
| MRI thoracic spine without contrast | CPT 72146 | $1,173.12 |
| MRI lumbar spine without contrast | CPT 72148 | $1,252.16 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,256.96 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,695.36 |
| MRI lumbar spine with contrast | CPT 72158 | $1,695.36 |
| CT pelvis without contrast | CPT 72192 | $658.56 |
| CT pelvis with contrast | CPT 72193 | $757.76 |
| Shoulder X-ray | CPT 73030 | $37.76 |
| Humerus X-ray | CPT 73060 | $94.4 |
| Hand X-ray 3 views | CPT 73130 | $119.36 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,227.2 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,256.96 |
| Knee X-ray 1-2 views | CPT 73560 | $108.48 |
| Ankle X-ray 3 views | CPT 73610 | $119.36 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,214.4 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,296.96 |
| CT abdomen without contrast | CPT 74150 | $757.76 |
| CT abdomen with contrast | CPT 74160 | $932.48 |
| CT abdomen with and without contrast | CPT 74170 | $1,395.2 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,414.08 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,687.36 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,325.44 |
| MRI abdomen without contrast | CPT 74181 | $1,714.88 |
| MRI abdomen with and without contrast | CPT 74183 | $2,216.64 |
| Abdominal ultrasound complete | CPT 76700 | $311.36 |
| Abdominal ultrasound limited | CPT 76705 | $222.4 |
| Retroperitoneal ultrasound complete | CPT 76770 | $222.4 |
| Obstetric ultrasound first trimester | CPT 76801 | $251.84 |
| Obstetric ultrasound after first trimester | CPT 76805 | $161.92 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $132.48 |
| Transvaginal ultrasound | CPT 76830 | $315.2 |
| Pelvic ultrasound complete | CPT 76856 | $290.56 |
| Scrotal ultrasound | CPT 76870 | $227.84 |
| Diagnostic mammography unilateral | CPT 77065 | $176.32 |
| Diagnostic mammography bilateral | CPT 77066 | $216 |
| Screening mammography bilateral | CPT 77067 | $189.44 |
| EKG complete | CPT 93000 | $14.01 |
| EKG tracing only | CPT 93005 | $6.05 |
| EKG interpretation only | CPT 93010 | $7.96 |
| Transthoracic echocardiogram complete | CPT 93306 | $135.18 |
| Transthoracic echocardiogram | CPT 93307 | $97.92 |
| Initial hospital care, low complexity | CPT 99221 | $83.07 |
| Initial hospital care, moderate complexity | CPT 99222 | $127.41 |
| Initial hospital care, high complexity | CPT 99223 | $169.99 |
| Hospital discharge, <30 min | CPT 99238 | $77.34 |
| Hospital discharge, >30 min | CPT 99239 | $109.53 |
| Basic metabolic panel (BMP) | CPT 80048 | $48.32 |
| General health panel | CPT 80050 | $207.04 |
| Electrolyte panel | CPT 80051 | $53.76 |
| Comprehensive metabolic panel | CPT 80053 | $76.16 |
| Lipid panel | CPT 80061 | $88 |
| Renal function panel | CPT 80069 | $53.44 |
| Hepatic function panel | CPT 80076 | $70.72 |
| Urinalysis non-automated | CPT 81002 | $3.48 |
| Urinalysis automated | CPT 81003 | $20.8 |
| Glucose quantitative | CPT 82947 | $32.32 |
| Hemoglobin A1c | CPT 83036 | $53.76 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $93.12 |
| Complete blood count with automated differential | CPT 85025 | $38.4 |
| Complete blood count without differential | CPT 85027 | $29.12 |
| Urine culture bacterial | CPT 87086 | $42.88 |
| Urine culture identification | CPT 87088 | $38.4 |
| Tissue exam by pathologist level IV | CPT 88305 | $85.12 |
| Fetal non-stress test | CPT 59025 | $47.1 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $2,322.79 |
| Vaginal delivery only | CPT 59409 | $775.06 |
| Vaginal delivery with postpartum | CPT 59410 | $1,025.45 |
| Routine obstetric care with C-section | CPT 59510 | $2,561.36 |
| C-section delivery only | CPT 59514 | $895.76 |
| C-section with postpartum | CPT 59515 | $1,258.92 |
| Office visit, new patient, 15-29 min | CPT 99202 | $65.43 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $99.48 |
| Office visit, new patient, 45-59 min | CPT 99204 | $150.81 |
| Office visit, new patient, 60-74 min | CPT 99205 | $201.86 |
| Office visit, established patient, 5 min | CPT 99211 | $15.85 |
| Office visit, established patient, 10-19 min | CPT 99212 | $42.06 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $70.03 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $104.91 |
| Office visit, established patient, 40-54 min | CPT 99215 | $148.74 |
| Upper GI endoscopy diagnostic | CPT 43235 | $193.32 |
| Upper GI endoscopy with biopsy | CPT 43239 | $235.15 |
| Sigmoidoscopy diagnostic | CPT 45330 | $116.59 |
| Sigmoidoscopy with biopsy | CPT 45331 | $163.21 |
| Colonoscopy diagnostic | CPT 45378 | $283.51 |
| Colonoscopy with biopsy | CPT 45380 | $308.27 |
| Colonoscopy with polyp removal | CPT 45385 | $389.24 |
| Total shoulder arthroplasty | CPT 23472 | $1,407.52 |
| Hip hemiarthroplasty | CPT 27125 | $1,103.46 |
| Total hip replacement | CPT 27130 | $1,250.6 |
| Total knee replacement | CPT 27447 | $1,257.7 |
| Knee revision arthroplasty single component | CPT 27486 | $1,367.02 |
| Knee revision arthroplasty all components | CPT 27487 | $1,703.46 |
| Shoulder arthroscopy with decompression | CPT 29826 | $167.93 |
| Shoulder arthroscopy with rotator cuff repair | CPT 29827 | $1,044.33 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $536.03 |
| ACL reconstruction | CPT 29888 | $952.99 |
| Open appendectomy | CPT 44950 | $622.09 |
| Laparoscopic appendectomy | CPT 44970 | $585.28 |
| Laparoscopic cholecystectomy | CPT 47562 | $640.84 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $697.48 |
| Lap inguinal hernia repair | CPT 49650 | $422.02 |
| Total abdominal hysterectomy | CPT 58150 | $992.68 |
| Vaginal hysterectomy | CPT 58260 | $820.46 |
| Lap-assisted vaginal hysterectomy | CPT 58550 | $862.66 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $959.26 |
| Lap salpingo-oophorectomy | CPT 58661 | $637.45 |
