| CT head without contrast | CPT 70450 | $1,786.19 |
| CT neck with contrast | CPT 70491 | $2,325.39 |
| MRI brain without contrast | CPT 70551 | $2,573.63 |
| MRI brain with and without contrast | CPT 70553 | $4,006.52 |
| Chest X-ray single view | CPT 71045 | $274.42 |
| Chest X-ray 2 views | CPT 71046 | $301.84 |
| CT chest without contrast | CPT 71250 | $1,865.50 |
| CT chest with contrast | CPT 71260 | $2,470.95 |
| CT chest with and without contrast | CPT 71270 | $2,690.38 |
| Lumbosacral spine X-ray | CPT 72100 | $384.12 |
| CT cervical spine without contrast | CPT 72125 | $2,085.01 |
| CT thoracic spine without contrast | CPT 72128 | $1,911.35 |
| CT lumbar spine without contrast | CPT 72131 | $2,194.66 |
| MRI cervical spine without contrast | CPT 72141 | $2,573.63 |
| MRI thoracic spine without contrast | CPT 72146 | $2,922.64 |
| MRI lumbar spine without contrast | CPT 72148 | $2,760.12 |
| CT pelvis without contrast | CPT 72192 | $1,712.28 |
| CT pelvis with contrast | CPT 72193 | $2,272.26 |
| Shoulder X-ray | CPT 73030 | $290.96 |
| Humerus X-ray | CPT 73060 | $265.29 |
| Hand X-ray 3 views | CPT 73130 | $275.06 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,743.33 |
| Knee X-ray 1-2 views | CPT 73560 | $248.71 |
| Ankle X-ray 3 views | CPT 73610 | $329.29 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,743.33 |
| CT abdomen without contrast | CPT 74150 | $1,800.30 |
| CT abdomen with contrast | CPT 74160 | $2,517.57 |
| CT abdomen with and without contrast | CPT 74170 | $2,837.98 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,182.27 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,787.69 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,226.63 |
| MRI abdomen without contrast | CPT 74181 | $2,473.20 |
| MRI abdomen with and without contrast | CPT 74183 | $3,609.74 |
| Abdominal ultrasound complete | CPT 76700 | $824.50 |
| Abdominal ultrasound limited | CPT 76705 | $661.17 |
| Retroperitoneal ultrasound complete | CPT 76770 | $788.04 |
| Obstetric ultrasound after first trimester | CPT 76805 | $636.14 |
| Transvaginal ultrasound | CPT 76830 | $549.78 |
| Pelvic ultrasound complete | CPT 76856 | $657.43 |
| Scrotal ultrasound | CPT 76870 | $813.11 |
| Diagnostic mammography unilateral | CPT 77065 | $357.84 |
| Diagnostic mammography bilateral | CPT 77066 | $471.67 |
| Screening mammography bilateral | CPT 77067 | $648.10 |
| EKG tracing only | CPT 93005 | $230.52 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,772.80 |
| Respiratory infections & inflammations w MCC | MS-DRG 177 | $27,185 |
| COPD w CC | MS-DRG 191 | $12,593 |
| COPD w/o CC/MCC | MS-DRG 192 | $23,962 |
| Simple pneumonia & pleurisy w CC | MS-DRG 194 | $21,723 |
| Heart failure & shock w CC | MS-DRG 292 | $16,840 |
| Heart failure & shock w/o CC/MCC | MS-DRG 293 | $17,946 |
| Kidney/UTI w/o MCC | MS-DRG 690 | $3,595.54 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $27,396 |
| Basic metabolic panel (BMP) | CPT 80048 | $184.41 |
| Comprehensive metabolic panel | CPT 80053 | $236.77 |
| Lipid panel | CPT 80061 | $385.48 |
| Renal function panel | CPT 80069 | $212.08 |
| Hepatic function panel | CPT 80076 | $184.41 |
| Urinalysis automated | CPT 81003 | $71.44 |
| Glucose quantitative | CPT 82947 | $187.26 |
| Hemoglobin A1c | CPT 83036 | $143.01 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $208.89 |
| Complete blood count with automated differential | CPT 85025 | $106.85 |
| Complete blood count without differential | CPT 85027 | $91.42 |
| Urine culture identification | CPT 87088 | $129.54 |
| Tissue exam by pathologist level IV | CPT 88305 | $605.96 |
| Office visit, new patient, 15-29 min | CPT 99202 | $149.60 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $220.15 |
| Office visit, new patient, 45-59 min | CPT 99204 | $310.25 |
| Office visit, new patient, 60-74 min | CPT 99205 | $393.55 |
| Office visit, established patient, 5 min | CPT 99211 | $147.05 |
| Office visit, established patient, 10-19 min | CPT 99212 | $209.10 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $235.45 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $277.95 |
| Office visit, established patient, 40-54 min | CPT 99215 | $357.85 |
| Upper GI endoscopy diagnostic | CPT 43235 | $4,789.22 |
| Upper GI endoscopy with biopsy | CPT 43239 | $5,945.86 |
| Colonoscopy diagnostic | CPT 45378 | $4,543.77 |
| Colonoscopy with biopsy | CPT 45380 | $5,495.12 |
| Colonoscopy with polyp removal | CPT 45385 | $5,293.41 |
| Laparoscopic cholecystectomy | CPT 47562 | $10,531 |
| OR procedure for obesity w CC | MS-DRG 620 | $21,665 |
| OR procedure for obesity w/o CC/MCC | MS-DRG 621 | $19,733 |
