| ED visit level 1 | CPT 99281 | $32.50 |
| ED visit level 2 | CPT 99282 | $255.00 |
| ED visit level 3 | CPT 99283 | $444.50 |
| ED visit level 4 | CPT 99284 | $792.00 |
| ED visit level 5 | CPT 99285 | $1,125.00 |
| Critical care, first hour | CPT 99291 | $1,623.00 |
| CT head without contrast | CPT 70450 | $997.00 |
| CT head with contrast | CPT 70460 | $1,140.50 |
| CT head with and without contrast | CPT 70470 | $1,427.00 |
| CT neck with contrast | CPT 70491 | $1,245.50 |
| Chest X-ray single view | CPT 71045 | $119.00 |
| Chest X-ray 2 views | CPT 71046 | $126.00 |
| CT chest without contrast | CPT 71250 | $1,049.50 |
| CT chest with contrast | CPT 71260 | $1,355.00 |
| CT chest with and without contrast | CPT 71270 | $1,641.50 |
| Lumbosacral spine X-ray | CPT 72100 | $90.50 |
| CT cervical spine without contrast | CPT 72125 | $1,212.00 |
| CT thoracic spine without contrast | CPT 72128 | $1,039.50 |
| CT lumbar spine without contrast | CPT 72131 | $1,075.50 |
| CT pelvis without contrast | CPT 72192 | $1,003.50 |
| CT pelvis with contrast | CPT 72193 | $1,190.00 |
| Shoulder X-ray | CPT 73030 | $175.00 |
| Humerus X-ray | CPT 73060 | $66.50 |
| Hand X-ray 3 views | CPT 73130 | $129.00 |
| Knee X-ray 1-2 views | CPT 73560 | $72.50 |
| Ankle X-ray 3 views | CPT 73610 | $168.00 |
| CT abdomen without contrast | CPT 74150 | $974.00 |
| CT abdomen with contrast | CPT 74160 | $1,147.00 |
| CT abdomen with and without contrast | CPT 74170 | $1,515.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,993.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,437.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,642.00 |
| Abdominal ultrasound complete | CPT 76700 | $583.00 |
| Abdominal ultrasound limited | CPT 76705 | $583.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $373.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $482.50 |
| Obstetric ultrasound after first trimester | CPT 76805 | $482.50 |
| Transvaginal ultrasound | CPT 76830 | $381.50 |
| Pelvic ultrasound complete | CPT 76856 | $583.00 |
| Scrotal ultrasound | CPT 76870 | $456.50 |
| EKG complete | CPT 93000 | $51.50 |
| EKG tracing only | CPT 93005 | $62.50 |
| Basic metabolic panel (BMP) | CPT 80048 | $107.00 |
| Electrolyte panel | CPT 80051 | $90.00 |
| Comprehensive metabolic panel | CPT 80053 | $144.50 |
| Lipid panel | CPT 80061 | $79.50 |
| Renal function panel | CPT 80069 | $149.50 |
| Hepatic function panel | CPT 80076 | $98.00 |
| Urinalysis automated | CPT 81003 | $19.00 |
| Glucose quantitative | CPT 82947 | $12.00 |
| Hemoglobin A1c | CPT 83036 | $81.50 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $103.00 |
| Complete blood count with automated differential | CPT 85025 | $35.00 |
| Complete blood count without differential | CPT 85027 | $35.00 |
| Urine culture bacterial | CPT 87086 | $9.00 |
| Tissue exam by pathologist level IV | CPT 88305 | $92.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $91.50 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $157.50 |
| Office visit, new patient, 45-59 min | CPT 99204 | $237.00 |
| Office visit, new patient, 60-74 min | CPT 99205 | $272.00 |
| Office visit, established patient, 5 min | CPT 99211 | $66.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $56.50 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $85.50 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $123.00 |
| Office visit, established patient, 40-54 min | CPT 99215 | $157.50 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,290.00 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,362.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | $887.00 |
| Colonoscopy diagnostic | CPT 45378 | $1,433.50 |
| Colonoscopy with biopsy | CPT 45380 | $1,940.50 |
| Colonoscopy with polyp removal | CPT 45385 | $1,290.00 |
| Laparoscopic cholecystectomy | CPT 47562 | $4,759.50 |
| Umbilical hernia repair age 5+ | CPT 49585 | $2,935.00 |
| Lap inguinal hernia repair | CPT 49650 | $4,721.00 |
