| ED visit level 1 | CPT 99281 | $135 |
| ED visit level 2 | CPT 99282 | $209.4 |
| ED visit level 3 | CPT 99283 | $377.4 |
| ED visit level 4 | CPT 99284 | $615 |
| ED visit level 5 | CPT 99285 | $884.4 |
| Critical care, first hour | CPT 99291 | $1,099.98 |
| CT head without contrast | CPT 70450 | $308.92 |
| CT head with contrast | CPT 70460 | $518.28 |
| CT head with and without contrast | CPT 70470 | $518.28 |
| CT neck with contrast | CPT 70491 | $518.28 |
| MRI brain without contrast | CPT 70551 | $705.04 |
| MRI brain with contrast | CPT 70552 | $1,030.87 |
| MRI brain with and without contrast | CPT 70553 | $1,030.87 |
| Chest X-ray single view | CPT 71045 | $94.2 |
| Chest X-ray 2 views | CPT 71046 | $117.2 |
| Chest X-ray 3 views | CPT 71047 | $201 |
| CT chest without contrast | CPT 71250 | $244.02 |
| CT chest with contrast | CPT 71260 | $518.28 |
| CT chest with and without contrast | CPT 71270 | $343.9 |
| MRI chest without contrast | CPT 71550 | $235.01 |
| MRI chest with and without contrast | CPT 71552 | $1,030.87 |
| Lumbosacral spine X-ray | CPT 72100 | $169.68 |
| CT cervical spine without contrast | CPT 72125 | $308.92 |
| CT thoracic spine without contrast | CPT 72128 | $308.92 |
| CT lumbar spine without contrast | CPT 72131 | $308.92 |
| MRI cervical spine without contrast | CPT 72141 | $556.92 |
| MRI thoracic spine without contrast | CPT 72146 | $235.01 |
| MRI lumbar spine without contrast | CPT 72148 | $1,037.82 |
| MRI lumbar spine with and without contrast | CPT 72149 | $937.02 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,030.87 |
| MRI lumbar spine with contrast | CPT 72158 | $1,030.87 |
| CT pelvis without contrast | CPT 72192 | $308.92 |
| CT pelvis with contrast | CPT 72193 | $518.28 |
| Shoulder X-ray | CPT 73030 | $239.4 |
| Humerus X-ray | CPT 73060 | $210 |
| Hand X-ray 3 views | CPT 73130 | $170.62 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,238.32 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,647.3 |
| Knee X-ray 1-2 views | CPT 73560 | $158.31 |
| Ankle X-ray 3 views | CPT 73610 | $140.7 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,133.58 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,943.4 |
| CT abdomen without contrast | CPT 74150 | $308.92 |
| CT abdomen with contrast | CPT 74160 | $518.28 |
| CT abdomen with and without contrast | CPT 74170 | $518.28 |
| CT abdomen and pelvis without contrast | CPT 74176 | $395.41 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,287.24 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $978.1 |
| MRI abdomen without contrast | CPT 74181 | $705.04 |
| MRI abdomen with and without contrast | CPT 74183 | $994.56 |
| Abdominal ultrasound complete | CPT 76700 | $308.92 |
| Abdominal ultrasound limited | CPT 76705 | $204.98 |
| Retroperitoneal ultrasound complete | CPT 76770 | $187.57 |
| Obstetric ultrasound first trimester | CPT 76801 | $177.66 |
| Obstetric ultrasound after first trimester | CPT 76805 | $199.08 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $235.01 |
| Transvaginal ultrasound | CPT 76830 | $255.5 |
| Pelvic ultrasound complete | CPT 76856 | $287.7 |
| Scrotal ultrasound | CPT 76870 | $239.4 |
| Diagnostic mammography unilateral | CPT 77065 | $123.75 |
| Diagnostic mammography bilateral | CPT 77066 | $270 |
| Screening mammography bilateral | CPT 77067 | $111.6 |
| EKG tracing only | CPT 93005 | $64.8 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,071.32 |
| Transthoracic echocardiogram | CPT 93307 | $315.42 |
| Basic metabolic panel (BMP) | CPT 80048 | $112.65 |
| General health panel | CPT 80050 | $96 |
| Electrolyte panel | CPT 80051 | $19.2 |
| Comprehensive metabolic panel | CPT 80053 | $28.8 |
| Lipid panel | CPT 80061 | $137.1 |
| Renal function panel | CPT 80069 | $82.8 |
| Hepatic function panel | CPT 80076 | $79.5 |
| Urinalysis non-automated | CPT 81002 | $6 |
| Urinalysis automated | CPT 81003 | $24.6 |
| Glucose quantitative | CPT 82947 | $27.6 |
| Hemoglobin A1c | CPT 83036 | $60 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $46.2 |
| Complete blood count with automated differential | CPT 85025 | $171 |
| Complete blood count without differential | CPT 85027 | $18 |
| Urine culture bacterial | CPT 87086 | $48 |
| Tissue exam by pathologist level IV | CPT 88305 | $74.4 |
| Fetal non-stress test | CPT 59025 | $315.5 |
| Vaginal delivery only | CPT 59409 | $3,293.44 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,199.9 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,404.03 |
| Colonoscopy diagnostic | CPT 45378 | $1,290.02 |
| Colonoscopy with biopsy | CPT 45380 | $1,872.78 |
| Colonoscopy with polyp removal | CPT 45385 | $1,872.78 |
| Total shoulder arthroplasty | CPT 23472 | $16,370 |
| Total hip replacement | CPT 27130 | $11,987 |
| Total knee replacement | CPT 27447 | $16,732 |
| Shoulder arthroscopy with decompression | CPT 29826 | $6,910.14 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $5,290.46 |
| Lap cholecystectomy with cholangiography | CPT 47563 | $7,760.92 |
| Vaginal hysterectomy | CPT 58260 | $6,471.36 |
| Lap-assisted vaginal hysterectomy >250g | CPT 58552 | $13,702 |
| Lap salpingo-oophorectomy | CPT 58661 | $8,977.36 |
| Complex cataract surgery | CPT 66982 | $2,962.66 |
| Cataract surgery with lens implant | CPT 66984 | $2,992.59 |
