| ED visit level 1 | CPT 99281 | $26.79 |
| ED visit level 2 | CPT 99282 | $210.74 |
| ED visit level 3 | CPT 99283 | $454.18 |
| ED visit level 4 | CPT 99284 | $1,065.56 |
| ED visit level 5 | CPT 99285 | $1,239.03 |
| Critical care, first hour | CPT 99291 | $1,347.60 |
| CT head without contrast | CPT 70450 | $1,049.26 |
| CT head with contrast | CPT 70460 | $1,635.37 |
| CT head with and without contrast | CPT 70470 | $1,583.13 |
| CT neck with contrast | CPT 70491 | $1,431.07 |
| MRI brain without contrast | CPT 70551 | $1,386.16 |
| MRI brain with contrast | CPT 70552 | $1,413.53 |
| MRI brain with and without contrast | CPT 70553 | $1,908.52 |
| Chest X-ray single view | CPT 71045 | $171.78 |
| Chest X-ray 2 views | CPT 71046 | $226.38 |
| Chest X-ray 3 views | CPT 71047 | $218.34 |
| CT chest without contrast | CPT 71250 | $1,196.97 |
| CT chest with contrast | CPT 71260 | $1,563.41 |
| CT chest with and without contrast | CPT 71270 | $1,680.02 |
| MRI chest without contrast | CPT 71550 | $1,159.96 |
| MRI chest with contrast | CPT 71551 | $1,417.04 |
| MRI chest with and without contrast | CPT 71552 | $1,794.71 |
| Lumbosacral spine X-ray | CPT 72100 | $372.71 |
| CT cervical spine without contrast | CPT 72125 | $1,186.17 |
| CT thoracic spine without contrast | CPT 72128 | $1,112.03 |
| CT lumbar spine without contrast | CPT 72131 | $1,210.56 |
| MRI cervical spine without contrast | CPT 72141 | $1,327.88 |
| MRI thoracic spine without contrast | CPT 72146 | $1,444.35 |
| MRI lumbar spine without contrast | CPT 72148 | $1,355.38 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,413.53 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,766.60 |
| MRI lumbar spine with contrast | CPT 72158 | $2,265.68 |
| CT pelvis without contrast | CPT 72192 | $1,213.23 |
| CT pelvis with contrast | CPT 72193 | $1,807.38 |
| Shoulder X-ray | CPT 73030 | $280.75 |
| Humerus X-ray | CPT 73060 | $214.88 |
| Hand X-ray 3 views | CPT 73130 | $260.68 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,416.06 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,784.72 |
| Knee X-ray 1-2 views | CPT 73560 | $208.97 |
| Ankle X-ray 3 views | CPT 73610 | $260.05 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,489.62 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,783.61 |
| CT abdomen without contrast | CPT 74150 | $1,101.77 |
| CT abdomen with contrast | CPT 74160 | $1,562.34 |
| CT abdomen with and without contrast | CPT 74170 | $1,928.92 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,995.46 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,512.54 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,002.08 |
| MRI abdomen without contrast | CPT 74181 | $1,155.88 |
| MRI abdomen with and without contrast | CPT 74183 | $1,774.37 |
| Abdominal ultrasound complete | CPT 76700 | $762.07 |
| Abdominal ultrasound limited | CPT 76705 | $627.78 |
| Retroperitoneal ultrasound complete | CPT 76770 | $674.65 |
| Obstetric ultrasound first trimester | CPT 76801 | $323.89 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,021.28 |
| Transvaginal ultrasound | CPT 76830 | $499.53 |
| Pelvic ultrasound complete | CPT 76856 | $640.57 |
| Scrotal ultrasound | CPT 76870 | $586.11 |
| Diagnostic mammography unilateral | CPT 77065 | $324.55 |
| Diagnostic mammography bilateral | CPT 77066 | $399.23 |
| Screening mammography bilateral | CPT 77067 | $339.30 |
| EKG complete | CPT 93000 | $146.33 |
| EKG tracing only | CPT 93005 | $130.96 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,538.36 |
| Basic metabolic panel (BMP) | CPT 80048 | $86.54 |
| Electrolyte panel | CPT 80051 | $47.94 |
| Comprehensive metabolic panel | CPT 80053 | $150.46 |
| Lipid panel | CPT 80061 | $16.04 |
| Renal function panel | CPT 80069 | $98.13 |
| Hepatic function panel | CPT 80076 | $81.74 |
| Urinalysis non-automated | CPT 81002 | $12.62 |
| Urinalysis automated | CPT 81003 | $17.77 |
| Glucose quantitative | CPT 82947 | $19.68 |
| Hemoglobin A1c | CPT 83036 | $79.61 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $47.13 |
| Complete blood count with automated differential | CPT 85025 | $49.31 |
| Urine culture bacterial | CPT 87086 | $47.58 |
| Urine culture identification | CPT 87088 | $33.67 |
| Tissue exam by pathologist level IV | CPT 88305 | $101.51 |
| Vaginal delivery only | CPT 59409 | $698.06 |
| C-section delivery only | CPT 59514 | $783.70 |
| Office visit, new patient, 15-29 min | CPT 99202 | $103.10 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $153.48 |
| Office visit, new patient, 45-59 min | CPT 99204 | $233.71 |
| Office visit, new patient, 60-74 min | CPT 99205 | $160.31 |
| Office visit, established patient, 5 min | CPT 99211 | $22.93 |
| Office visit, established patient, 10-19 min | CPT 99212 | $60.40 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $54.23 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $266.54 |
| Office visit, established patient, 40-54 min | CPT 99215 | $214.19 |
