| ED visit level 1 | CPT 99281 | $2,303.29 |
| ED visit level 2 | CPT 99282 | $2,858.05 |
| ED visit level 3 | CPT 99283 | $2,858.05 |
| ED visit level 4 | CPT 99284 | $2,488.21 |
| ED visit level 5 | CPT 99285 | $2,517.02 |
| Critical care, first hour | CPT 99291 | $2,510.99 |
| CT head without contrast | CPT 70450 | $1,448 |
| CT head with and without contrast | CPT 70470 | $1,448 |
| CT neck with contrast | CPT 70491 | $1,448 |
| MRI brain without contrast | CPT 70551 | $1,298 |
| MRI brain with contrast | CPT 70552 | $1,298 |
| MRI brain with and without contrast | CPT 70553 | $1,298 |
| Chest X-ray single view | CPT 71045 | $167.5 |
| Chest X-ray 2 views | CPT 71046 | $244.89 |
| Chest X-ray 3 views | CPT 71047 | $231.15 |
| CT chest without contrast | CPT 71250 | $1,448 |
| CT chest with contrast | CPT 71260 | $1,448 |
| CT chest with and without contrast | CPT 71270 | $1,448 |
| MRI chest without contrast | CPT 71550 | $1,298 |
| MRI chest with and without contrast | CPT 71552 | $1,298 |
| Lumbosacral spine X-ray | CPT 72100 | $239.53 |
| CT cervical spine without contrast | CPT 72125 | $1,448 |
| CT thoracic spine without contrast | CPT 72128 | $1,448 |
| CT lumbar spine without contrast | CPT 72131 | $1,448 |
| MRI cervical spine without contrast | CPT 72141 | $1,298 |
| MRI thoracic spine without contrast | CPT 72146 | $1,298 |
| MRI lumbar spine without contrast | CPT 72148 | $1,298 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,298 |
| MRI lumbar spine with contrast | CPT 72158 | $1,298 |
| CT pelvis without contrast | CPT 72192 | $1,448 |
| CT pelvis with contrast | CPT 72193 | $1,448 |
| Shoulder X-ray | CPT 73030 | $269.01 |
| Humerus X-ray | CPT 73060 | $174.54 |
| Hand X-ray 3 views | CPT 73130 | $190.28 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,860.14 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,782.81 |
| Knee X-ray 1-2 views | CPT 73560 | $172.36 |
| Ankle X-ray 3 views | CPT 73610 | $192.46 |
| MRI lower extremity joint without contrast | CPT 73721 | $33.8 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,298 |
| CT abdomen without contrast | CPT 74150 | $1,448 |
| CT abdomen with contrast | CPT 74160 | $1,448 |
| CT abdomen with and without contrast | CPT 74170 | $1,448 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,448 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,448 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,666.83 |
| MRI abdomen without contrast | CPT 74181 | $1,298 |
| MRI abdomen with and without contrast | CPT 74183 | $1,298 |
| Abdominal ultrasound complete | CPT 76700 | $380.9 |
| Abdominal ultrasound limited | CPT 76705 | $215.41 |
| Retroperitoneal ultrasound complete | CPT 76770 | $221.6 |
| Obstetric ultrasound first trimester | CPT 76801 | $221.6 |
| Obstetric ultrasound after first trimester | CPT 76805 | $221.6 |
| Transvaginal ultrasound | CPT 76830 | $112.39 |
| Pelvic ultrasound complete | CPT 76856 | $112.39 |
| Scrotal ultrasound | CPT 76870 | $226.13 |
| Diagnostic mammography unilateral | CPT 77065 | $247.23 |
| Diagnostic mammography bilateral | CPT 77066 | $247.23 |
| Screening mammography bilateral | CPT 77067 | $239.02 |
| EKG tracing only | CPT 93005 | $177.38 |
| Transthoracic echocardiogram complete | CPT 93306 | $886.41 |
| Stress echocardiogram | CPT 93350 | $119.26 |
| Basic metabolic panel (BMP) | CPT 80048 | $139.26 |
| General health panel | CPT 80050 | $464.43 |
| Electrolyte panel | CPT 80051 | $63.86 |
| Comprehensive metabolic panel | CPT 80053 | $208.16 |
| Lipid panel | CPT 80061 | $176.31 |
| Renal function panel | CPT 80069 | $93.11 |
| Hepatic function panel | CPT 80076 | $208.98 |
| Urinalysis automated | CPT 81003 | $27.83 |
| Glucose quantitative | CPT 82947 | $62.95 |
| Hemoglobin A1c | CPT 83036 | $101.42 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $105.79 |
| Complete blood count with automated differential | CPT 85025 | $89.86 |
| Complete blood count without differential | CPT 85027 | $37.54 |
| Urine culture bacterial | CPT 87086 | $134.88 |
| Tissue exam by pathologist level IV | CPT 88305 | $153.4 |
| Office visit, new patient, 15-29 min | CPT 99202 | $103.85 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $119.26 |
| Office visit, established patient, 5 min | CPT 99211 | $103.85 |
| Office visit, established patient, 10-19 min | CPT 99212 | $103.85 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $119.26 |
