| ED visit level 1 | CPT 99281 | $181.24 |
| ED visit level 2 | CPT 99282 | $289.98 |
| ED visit level 3 | CPT 99283 | $445.73 |
| ED visit level 4 | CPT 99284 | $697.55 |
| ED visit level 5 | CPT 99285 | $1,072.35 |
| Critical care, first hour | CPT 99291 | $925.25 |
| CT head without contrast | CPT 70450 | $635.05 |
| CT head with contrast | CPT 70460 | $774.18 |
| CT head with and without contrast | CPT 70470 | $889.35 |
| CT neck with contrast | CPT 70491 | $689.02 |
| MRI brain without contrast | CPT 70551 | $1,093.38 |
| MRI brain with contrast | CPT 70552 | $1,393.94 |
| MRI brain with and without contrast | CPT 70553 | $1,860.42 |
| Chest X-ray single view | CPT 71045 | $202.53 |
| Chest X-ray 2 views | CPT 71046 | $198.72 |
| Chest X-ray 3 views | CPT 71047 | $235.9 |
| CT chest without contrast | CPT 71250 | $713.52 |
| CT chest with contrast | CPT 71260 | $884.15 |
| CT chest with and without contrast | CPT 71270 | $1,188.14 |
| MRI chest without contrast | CPT 71550 | $1,090.17 |
| MRI chest with and without contrast | CPT 71552 | $1,632.11 |
| Lumbosacral spine X-ray | CPT 72100 | $150.56 |
| CT cervical spine without contrast | CPT 72125 | $640.89 |
| CT thoracic spine without contrast | CPT 72128 | $569.71 |
| CT lumbar spine without contrast | CPT 72131 | $669.21 |
| MRI cervical spine without contrast | CPT 72141 | $870.34 |
| MRI thoracic spine without contrast | CPT 72146 | $884.78 |
| MRI lumbar spine without contrast | CPT 72148 | $933.68 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,188.06 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,539.73 |
| MRI lumbar spine with contrast | CPT 72158 | $1,585.24 |
| CT pelvis without contrast | CPT 72192 | $556.6 |
| CT pelvis with contrast | CPT 72193 | $826.41 |
| Shoulder X-ray | CPT 73030 | $118.39 |
| Humerus X-ray | CPT 73060 | $129.42 |
| Hand X-ray 3 views | CPT 73130 | $191.45 |
| MRI upper extremity joint without contrast | CPT 73221 | $957.58 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,290.05 |
| Knee X-ray 1-2 views | CPT 73560 | $117.92 |
| Ankle X-ray 3 views | CPT 73610 | $156.01 |
| MRI lower extremity joint without contrast | CPT 73721 | $992.49 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,449.1 |
| CT abdomen without contrast | CPT 74150 | $547.5 |
| CT abdomen with contrast | CPT 74160 | $909.64 |
| CT abdomen with and without contrast | CPT 74170 | $1,140.26 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,036.57 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,754.57 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,821.18 |
| MRI abdomen without contrast | CPT 74181 | $1,014.84 |
| MRI abdomen with and without contrast | CPT 74183 | $1,765.39 |
| Abdominal ultrasound complete | CPT 76700 | $246.85 |
| Abdominal ultrasound limited | CPT 76705 | $233.31 |
| Retroperitoneal ultrasound complete | CPT 76770 | $253.64 |
| Obstetric ultrasound first trimester | CPT 76801 | $204.78 |
| Obstetric ultrasound after first trimester | CPT 76805 | $255.5 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $379.39 |
| Transvaginal ultrasound | CPT 76830 | $265.55 |
| Pelvic ultrasound complete | CPT 76856 | $274.32 |
| Scrotal ultrasound | CPT 76870 | $148.05 |
| Diagnostic mammography unilateral | CPT 77065 | $194.09 |
| Diagnostic mammography bilateral | CPT 77066 | $248.28 |
| Screening mammography bilateral | CPT 77067 | $254.92 |
| EKG tracing only | CPT 93005 | $82.14 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,061.58 |
| Transthoracic echocardiogram | CPT 93307 | $684.81 |
| Stress echocardiogram | CPT 93350 | $854.57 |
| Basic metabolic panel (BMP) | CPT 80048 | $95.25 |
| Electrolyte panel | CPT 80051 | $30.26 |
| Comprehensive metabolic panel | CPT 80053 | $127 |
| Lipid panel | CPT 80061 | $40.98 |
| Renal function panel | CPT 80069 | $40.52 |
| Hepatic function panel | CPT 80076 | $100.23 |
| Urinalysis non-automated | CPT 81002 | $12.3 |
| Urinalysis automated | CPT 81003 | $9.14 |
| Glucose quantitative | CPT 82947 | $17.84 |
| Hemoglobin A1c | CPT 83036 | $46.03 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $68.41 |
| Complete blood count with automated differential | CPT 85025 | $54.65 |
| Complete blood count without differential | CPT 85027 | $36.75 |
| Urine culture bacterial | CPT 87086 | $31.8 |
| Tissue exam by pathologist level IV | CPT 88305 | $165.6 |
| Fetal non-stress test | CPT 59025 | $208.87 |
| Office visit, new patient, 15-29 min | CPT 99202 | $78.5 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $80.15 |
| Office visit, new patient, 45-59 min | CPT 99204 | $88.75 |
| Office visit, new patient, 60-74 min | CPT 99205 | $105.59 |
| Office visit, established patient, 5 min | CPT 99211 | $53.2 |
| Office visit, established patient, 10-19 min | CPT 99212 | $61.21 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $114.33 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $81 |
| Office visit, established patient, 40-54 min | CPT 99215 | $94.89 |
