| ED visit level 3 | CPT 99283 | $776.32 |
| ED visit level 4 | CPT 99284 | $1,222.95 |
| ED visit level 5 | CPT 99285 | $1,528.83 |
| CT head without contrast | CPT 70450 | $870.55 |
| CT head with contrast | CPT 70460 | $331.88 |
| MRI brain without contrast | CPT 70551 | $1,262.75 |
| MRI brain with contrast | CPT 70552 | $2,031.76 |
| MRI brain with and without contrast | CPT 70553 | $3,163.98 |
| Chest X-ray single view | CPT 71045 | $97.90 |
| Chest X-ray 2 views | CPT 71046 | $161.75 |
| CT chest without contrast | CPT 71250 | $1,226.66 |
| CT chest with contrast | CPT 71260 | $1,451.46 |
| CT chest with and without contrast | CPT 71270 | $1,632.48 |
| Lumbosacral spine X-ray | CPT 72100 | $161.75 |
| CT cervical spine without contrast | CPT 72125 | $948.48 |
| CT thoracic spine without contrast | CPT 72128 | $948.48 |
| CT lumbar spine without contrast | CPT 72131 | $1,006.66 |
| MRI cervical spine without contrast | CPT 72141 | $1,628.81 |
| MRI thoracic spine without contrast | CPT 72146 | $1,628.81 |
| MRI lumbar spine without contrast | CPT 72148 | $1,628.81 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,439.92 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,163.98 |
| MRI lumbar spine with contrast | CPT 72158 | $3,163.98 |
| CT pelvis without contrast | CPT 72192 | $977.51 |
| CT pelvis with contrast | CPT 72193 | $993.37 |
| Shoulder X-ray | CPT 73030 | $161.75 |
| Humerus X-ray | CPT 73060 | $161.75 |
| Hand X-ray 3 views | CPT 73130 | $143.28 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,368.20 |
| Knee X-ray 1-2 views | CPT 73560 | $132.09 |
| Ankle X-ray 3 views | CPT 73610 | $140.45 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,311.47 |
| CT abdomen without contrast | CPT 74150 | $171.69 |
| CT abdomen with and without contrast | CPT 74170 | $371.53 |
| CT abdomen and pelvis without contrast | CPT 74176 | $668.97 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,035.74 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $534.34 |
| MRI abdomen without contrast | CPT 74181 | $1,628.81 |
| MRI abdomen with and without contrast | CPT 74183 | $2,421.22 |
| Abdominal ultrasound complete | CPT 76700 | $312.43 |
| Abdominal ultrasound limited | CPT 76705 | $225.59 |
| Retroperitoneal ultrasound complete | CPT 76770 | $356.13 |
| EKG tracing only | CPT 93005 | $37.29 |
| Transthoracic echocardiogram complete | CPT 93306 | $892.44 |
| Basic metabolic panel (BMP) | CPT 80048 | $123.44 |
| Comprehensive metabolic panel | CPT 80053 | $62.45 |
| Lipid panel | CPT 80061 | $48.43 |
| Renal function panel | CPT 80069 | $31.21 |
| Hepatic function panel | CPT 80076 | $53.21 |
| Urinalysis automated | CPT 81003 | $20.26 |
| Glucose quantitative | CPT 82947 | $10.57 |
| Hemoglobin A1c | CPT 83036 | $50.66 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $75.31 |
| Complete blood count with automated differential | CPT 85025 | $38.31 |
| Complete blood count without differential | CPT 85027 | $40.08 |
| Urine culture bacterial | CPT 87086 | $29.43 |
| Tissue exam by pathologist level IV | CPT 88305 | $43.40 |
| Office visit, new patient, 15-29 min | CPT 99202 | $72.91 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $101.45 |
| Office visit, new patient, 45-59 min | CPT 99204 | $129.44 |
| Office visit, new patient, 60-74 min | CPT 99205 | $223.47 |
| Office visit, established patient, 5 min | CPT 99211 | $72.91 |
| Office visit, established patient, 10-19 min | CPT 99212 | $72.91 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $78.87 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $98.95 |
| Office visit, established patient, 40-54 min | CPT 99215 | $143.30 |
