| ED visit level 1 | CPT 99281 | $32.5 |
| ED visit level 2 | CPT 99282 | $255 |
| ED visit level 3 | CPT 99283 | $444.5 |
| ED visit level 4 | CPT 99284 | $792 |
| ED visit level 5 | CPT 99285 | $1,125 |
| Critical care, first hour | CPT 99291 | $1,623 |
| CT head without contrast | CPT 70450 | $997 |
| CT head with contrast | CPT 70460 | $1,140.5 |
| CT head with and without contrast | CPT 70470 | $1,427 |
| CT neck with contrast | CPT 70491 | $1,245.5 |
| Chest X-ray single view | CPT 71045 | $119 |
| Chest X-ray 2 views | CPT 71046 | $126 |
| CT chest without contrast | CPT 71250 | $1,049.5 |
| CT chest with contrast | CPT 71260 | $1,355 |
| CT chest with and without contrast | CPT 71270 | $1,641.5 |
| Lumbosacral spine X-ray | CPT 72100 | $90.5 |
| CT cervical spine without contrast | CPT 72125 | $1,212 |
| CT thoracic spine without contrast | CPT 72128 | $1,039.5 |
| CT lumbar spine without contrast | CPT 72131 | $1,075.5 |
| CT pelvis without contrast | CPT 72192 | $1,003.5 |
| CT pelvis with contrast | CPT 72193 | $1,190 |
| Shoulder X-ray | CPT 73030 | $175 |
| Humerus X-ray | CPT 73060 | $66.5 |
| Hand X-ray 3 views | CPT 73130 | $129 |
| Knee X-ray 1-2 views | CPT 73560 | $72.5 |
| Ankle X-ray 3 views | CPT 73610 | $168 |
| CT abdomen without contrast | CPT 74150 | $974 |
| CT abdomen with contrast | CPT 74160 | $1,147 |
| CT abdomen with and without contrast | CPT 74170 | $1,515 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,993 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,437 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,642 |
| Abdominal ultrasound complete | CPT 76700 | $583 |
| Abdominal ultrasound limited | CPT 76705 | $583 |
| Retroperitoneal ultrasound complete | CPT 76770 | $373 |
| Obstetric ultrasound first trimester | CPT 76801 | $482.5 |
| Obstetric ultrasound after first trimester | CPT 76805 | $482.5 |
| Transvaginal ultrasound | CPT 76830 | $381.5 |
| Pelvic ultrasound complete | CPT 76856 | $583 |
| Scrotal ultrasound | CPT 76870 | $456.5 |
| EKG complete | CPT 93000 | $51.5 |
| EKG tracing only | CPT 93005 | $62.5 |
| Basic metabolic panel (BMP) | CPT 80048 | $107 |
| Electrolyte panel | CPT 80051 | $90 |
| Comprehensive metabolic panel | CPT 80053 | $144.5 |
| Lipid panel | CPT 80061 | $79.5 |
| Renal function panel | CPT 80069 | $149.5 |
| Hepatic function panel | CPT 80076 | $98 |
| Urinalysis automated | CPT 81003 | $19 |
| Glucose quantitative | CPT 82947 | $12 |
| Hemoglobin A1c | CPT 83036 | $81.5 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $103 |
| Complete blood count with automated differential | CPT 85025 | $35 |
| Complete blood count without differential | CPT 85027 | $35 |
| Urine culture bacterial | CPT 87086 | $9 |
| Tissue exam by pathologist level IV | CPT 88305 | $92 |
| Office visit, new patient, 15-29 min | CPT 99202 | $91.5 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $157.5 |
| Office visit, new patient, 45-59 min | CPT 99204 | $237 |
| Office visit, new patient, 60-74 min | CPT 99205 | $272 |
| Office visit, established patient, 5 min | CPT 99211 | $66 |
| Office visit, established patient, 10-19 min | CPT 99212 | $56.5 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $85.5 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $123 |
| Office visit, established patient, 40-54 min | CPT 99215 | $157.5 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,290 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,362 |
| Sigmoidoscopy with biopsy | CPT 45331 | $887 |
| Colonoscopy diagnostic | CPT 45378 | $1,433.5 |
| Colonoscopy with biopsy | CPT 45380 | $1,940.5 |
| Colonoscopy with polyp removal | CPT 45385 | $1,290 |
| Laparoscopic cholecystectomy | CPT 47562 | $4,759.5 |
| Umbilical hernia repair age 5+ | CPT 49585 | $2,935 |
| Lap inguinal hernia repair | CPT 49650 | $4,721 |
