| ED visit level 2 | CPT 99282 | $462.82 |
| ED visit level 3 | CPT 99283 | $815.41 |
| ED visit level 4 | CPT 99284 | $1,281.74 |
| ED visit level 5 | CPT 99285 | $1,839.78 |
| Critical care, first hour | CPT 99291 | $2,624.55 |
| CT head without contrast | CPT 70450 | $1,878.44 |
| CT head with contrast | CPT 70460 | $2,198.31 |
| CT head with and without contrast | CPT 70470 | $2,567.52 |
| CT neck with contrast | CPT 70491 | $2,256.19 |
| MRI brain without contrast | CPT 70551 | $2,889.65 |
| MRI brain with contrast | CPT 70552 | $3,297.26 |
| MRI brain with and without contrast | CPT 70553 | $4,118.09 |
| Chest X-ray single view | CPT 71045 | $283.39 |
| Chest X-ray 2 views | CPT 71046 | $341.42 |
| Chest X-ray 3 views | CPT 71047 | $531.56 |
| CT chest without contrast | CPT 71250 | $2,028.80 |
| CT chest with contrast | CPT 71260 | $2,401.78 |
| CT chest with and without contrast | CPT 71270 | $2,832.09 |
| MRI chest without contrast | CPT 71550 | $2,866.90 |
| MRI chest with and without contrast | CPT 71552 | $3,969.00 |
| Lumbosacral spine X-ray | CPT 72100 | $421.51 |
| CT cervical spine without contrast | CPT 72125 | $2,253.83 |
| CT thoracic spine without contrast | CPT 72128 | $2,153.29 |
| CT lumbar spine without contrast | CPT 72131 | $2,268.98 |
| MRI cervical spine without contrast | CPT 72141 | $2,953.82 |
| MRI thoracic spine without contrast | CPT 72146 | $2,960.98 |
| MRI lumbar spine without contrast | CPT 72148 | $2,959.04 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,260.45 |
| MRI cervical spine with and without contrast | CPT 72156 | $4,125.40 |
| MRI lumbar spine with contrast | CPT 72158 | $4,132.17 |
| CT pelvis without contrast | CPT 72192 | $2,000.49 |
| CT pelvis with contrast | CPT 72193 | $2,100.51 |
| Shoulder X-ray | CPT 73030 | $368.55 |
| Humerus X-ray | CPT 73060 | $329.96 |
| Hand X-ray 3 views | CPT 73130 | $346.90 |
| MRI upper extremity joint without contrast | CPT 73221 | $3,749.06 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,744.56 |
| Knee X-ray 1-2 views | CPT 73560 | $319.88 |
| Ankle X-ray 3 views | CPT 73610 | $354.38 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,764.10 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,770.55 |
| CT abdomen without contrast | CPT 74150 | $2,066.13 |
| CT abdomen with contrast | CPT 74160 | $2,473.54 |
| CT abdomen with and without contrast | CPT 74170 | $2,923.61 |
| CT abdomen and pelvis without contrast | CPT 74176 | $793.94 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,360.68 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,312.50 |
| MRI abdomen without contrast | CPT 74181 | $2,649.01 |
| MRI abdomen with and without contrast | CPT 74183 | $3,947.64 |
| Abdominal ultrasound complete | CPT 76700 | $969.71 |
| Abdominal ultrasound limited | CPT 76705 | $715.12 |
| Retroperitoneal ultrasound complete | CPT 76770 | $802.17 |
| Transvaginal ultrasound | CPT 76830 | $676.86 |
| Pelvic ultrasound complete | CPT 76856 | $791.87 |
| Scrotal ultrasound | CPT 76870 | $728.50 |
| Screening mammography bilateral | CPT 77067 | $333.44 |
| EKG tracing only | CPT 93005 | $187.50 |
| Transthoracic echocardiogram complete | CPT 93306 | $442.97 |
| Transthoracic echocardiogram | CPT 93307 | $1,182.75 |
| Stress echocardiogram | CPT 93350 | $1,672.40 |
| Basic metabolic panel (BMP) | CPT 80048 | $188.91 |
| Electrolyte panel | CPT 80051 | $139.09 |
| Comprehensive metabolic panel | CPT 80053 | $258.21 |
| Lipid panel | CPT 80061 | $181.62 |
| Renal function panel | CPT 80069 | $75.00 |
| Hepatic function panel | CPT 80076 | $190.19 |
| Urinalysis non-automated | CPT 81002 | $37.59 |
| Urinalysis automated | CPT 81003 | $75.00 |
| Glucose quantitative | CPT 82947 | $63.78 |
| Hemoglobin A1c | CPT 83036 | $112.11 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $177.79 |
| Complete blood count with automated differential | CPT 85025 | $115.01 |
| Complete blood count without differential | CPT 85027 | $48.53 |
| Urine culture bacterial | CPT 87086 | $127.78 |
| Urine culture identification | CPT 87088 | $100.12 |
| Tissue exam by pathologist level IV | CPT 88305 | $171.67 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,851.04 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,851.04 |
| Sigmoidoscopy diagnostic | CPT 45330 | $2,796.16 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,796.16 |
| Colonoscopy diagnostic | CPT 45378 | $2,796.16 |
| Colonoscopy with biopsy | CPT 45380 | $3,653.76 |
| Colonoscopy with polyp removal | CPT 45385 | $3,653.76 |
