| ED visit level 1 | CPT 99281 | $205.55 |
| ED visit level 2 | CPT 99282 | $378.67 |
| ED visit level 3 | CPT 99283 | $660.6 |
| ED visit level 4 | CPT 99284 | $1,025.46 |
| ED visit level 5 | CPT 99285 | $1,487.14 |
| Critical care, first hour | CPT 99291 | $2,105.25 |
| CT head without contrast | CPT 70450 | $1,881.78 |
| CT head with contrast | CPT 70460 | $1,881.78 |
| CT head with and without contrast | CPT 70470 | $1,881.78 |
| CT neck with contrast | CPT 70491 | $1,881.78 |
| MRI brain without contrast | CPT 70551 | $1,532.11 |
| MRI brain with contrast | CPT 70552 | $2,948.08 |
| MRI brain with and without contrast | CPT 70553 | $2,948.08 |
| Chest X-ray single view | CPT 71045 | $378.23 |
| Chest X-ray 2 views | CPT 71046 | $378.23 |
| CT chest without contrast | CPT 71250 | $770.67 |
| CT chest with contrast | CPT 71260 | $2,087.78 |
| CT chest with and without contrast | CPT 71270 | $2,087.78 |
| MRI chest without contrast | CPT 71550 | $1,682.31 |
| MRI chest with and without contrast | CPT 71552 | $2,948.08 |
| Lumbosacral spine X-ray | CPT 72100 | $345.16 |
| CT cervical spine without contrast | CPT 72125 | $770.67 |
| CT thoracic spine without contrast | CPT 72128 | $726.72 |
| CT lumbar spine without contrast | CPT 72131 | $726.72 |
| MRI cervical spine without contrast | CPT 72141 | $1,682.31 |
| MRI thoracic spine without contrast | CPT 72146 | $1,532.11 |
| MRI lumbar spine without contrast | CPT 72148 | $1,532.11 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,674 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,948.08 |
| MRI lumbar spine with contrast | CPT 72158 | $2,674 |
| CT pelvis without contrast | CPT 72192 | $726.72 |
| CT pelvis with contrast | CPT 72193 | $1,881.78 |
| Shoulder X-ray | CPT 73030 | $345.16 |
| Humerus X-ray | CPT 73060 | $345.16 |
| Hand X-ray 3 views | CPT 73130 | $378.23 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,532.11 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,674 |
| Knee X-ray 1-2 views | CPT 73560 | $345.16 |
| Ankle X-ray 3 views | CPT 73610 | $378.23 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,532.11 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,674 |
| CT abdomen without contrast | CPT 74150 | $770.67 |
| CT abdomen with contrast | CPT 74160 | $2,087.78 |
| CT abdomen with and without contrast | CPT 74170 | $2,087.78 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,087.78 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,087.78 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,087.78 |
| MRI abdomen without contrast | CPT 74181 | $1,682.31 |
| MRI abdomen with and without contrast | CPT 74183 | $2,948.08 |
| Abdominal ultrasound complete | CPT 76700 | $1,109.42 |
| Abdominal ultrasound limited | CPT 76705 | $730.8 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,262.49 |
| Pelvic ultrasound complete | CPT 76856 | $1,262.49 |
| Scrotal ultrasound | CPT 76870 | $971.73 |
| EKG tracing only | CPT 93005 | $104.47 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,839.44 |
| Basic metabolic panel (BMP) | CPT 80048 | $67.48 |
| General health panel | CPT 80050 | $67.48 |
| Electrolyte panel | CPT 80051 | $67.48 |
| Comprehensive metabolic panel | CPT 80053 | $68.65 |
| Lipid panel | CPT 80061 | $72.78 |
| Renal function panel | CPT 80069 | $72.78 |
| Hepatic function panel | CPT 80076 | $72.78 |
| Urinalysis non-automated | CPT 81002 | $23.71 |
| Urinalysis automated | CPT 81003 | $23.71 |
| Glucose quantitative | CPT 82947 | $39.81 |
| Hemoglobin A1c | CPT 83036 | $15.41 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $108.54 |
| Complete blood count with automated differential | CPT 85025 | $45.63 |
| Complete blood count without differential | CPT 85027 | $45.63 |
| Urine culture bacterial | CPT 87086 | $58.74 |
| Tissue exam by pathologist level IV | CPT 88305 | $710.18 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,885.26 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,791.63 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $12,856 |
| ACL reconstruction | CPT 29888 | $27,085 |
| Lap inguinal hernia repair | CPT 49650 | $8,202.04 |
| Lap salpingo-oophorectomy | CPT 58661 | $11,509 |
| Complex cataract surgery | CPT 66982 | $13,802 |
| Cataract surgery with lens implant | CPT 66984 | $14,791 |
| PCI with drug-eluting stent | CPT 92928 | $26,158 |
| Left heart catheterization | CPT 93452 | $9,331.75 |
| Coronary angiography with bypass cath | CPT 93458 | $7,523.87 |
