| ED visit level 1 | CPT 99281 | $283.29 |
| ED visit level 2 | CPT 99282 | $542.10 |
| ED visit level 3 | CPT 99283 | $958.10 |
| ED visit level 4 | CPT 99284 | $1,249.05 |
| ED visit level 5 | CPT 99285 | $1,898.00 |
| Critical care, first hour | CPT 99291 | $2,453.10 |
| CT head without contrast | CPT 70450 | $872.27 |
| CT head with contrast | CPT 70460 | $1,192.72 |
| CT head with and without contrast | CPT 70470 | $1,643.20 |
| CT neck with contrast | CPT 70491 | $1,369.10 |
| MRI brain without contrast | CPT 70551 | $1,406.58 |
| MRI brain with contrast | CPT 70552 | $2,689.70 |
| MRI brain with and without contrast | CPT 70553 | $3,597.10 |
| Chest X-ray single view | CPT 71045 | $93.08 |
| Chest X-ray 2 views | CPT 71046 | $322.59 |
| Chest X-ray 3 views | CPT 71047 | $346.62 |
| CT chest without contrast | CPT 71250 | $1,143.00 |
| CT chest with contrast | CPT 71260 | $1,275.09 |
| CT chest with and without contrast | CPT 71270 | $1,707.55 |
| MRI chest without contrast | CPT 71550 | $1,506.05 |
| MRI chest with and without contrast | CPT 71552 | $2,315.95 |
| Lumbosacral spine X-ray | CPT 72100 | $224.96 |
| CT cervical spine without contrast | CPT 72125 | $1,094.60 |
| CT thoracic spine without contrast | CPT 72128 | $967.85 |
| CT lumbar spine without contrast | CPT 72131 | $1,054.95 |
| MRI cervical spine without contrast | CPT 72141 | $2,401.75 |
| MRI thoracic spine without contrast | CPT 72146 | $1,596.40 |
| MRI lumbar spine without contrast | CPT 72148 | $2,485.60 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,929.55 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,773.55 |
| MRI lumbar spine with contrast | CPT 72158 | $3,075.80 |
| CT pelvis without contrast | CPT 72192 | — |
| CT pelvis with contrast | CPT 72193 | $1,671.15 |
| Shoulder X-ray | CPT 73030 | — |
| Humerus X-ray | CPT 73060 | — |
| Hand X-ray 3 views | CPT 73130 | $109.75 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,412.15 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,164.20 |
| Knee X-ray 1-2 views | CPT 73560 | $321.90 |
| Ankle X-ray 3 views | CPT 73610 | — |
| MRI lower extremity joint without contrast | CPT 73721 | $1,822.77 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,007.53 |
| CT abdomen without contrast | CPT 74150 | $1,150.50 |
| CT abdomen with contrast | CPT 74160 | $1,323.40 |
| CT abdomen with and without contrast | CPT 74170 | $1,485.90 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,089.89 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,774.49 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,419.00 |
| MRI abdomen without contrast | CPT 74181 | $1,835.60 |
| MRI abdomen with and without contrast | CPT 74183 | $2,627.95 |
| Abdominal ultrasound complete | CPT 76700 | $913.92 |
| Abdominal ultrasound limited | CPT 76705 | $1,010.60 |
| Retroperitoneal ultrasound complete | CPT 76770 | $504.35 |
| Obstetric ultrasound first trimester | CPT 76801 | $662.35 |
| Obstetric ultrasound after first trimester | CPT 76805 | $975.65 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,122.55 |
| Transvaginal ultrasound | CPT 76830 | $659.75 |
| Pelvic ultrasound complete | CPT 76856 | $489.28 |
| Scrotal ultrasound | CPT 76870 | $836.55 |
| Diagnostic mammography unilateral | CPT 77065 | $280.11 |
| Diagnostic mammography bilateral | CPT 77066 | $348.53 |
| Screening mammography bilateral | CPT 77067 | $40.81 |
| EKG tracing only | CPT 93005 | — |
| Transthoracic echocardiogram complete | CPT 93306 | $3,618.43 |
| Transthoracic echocardiogram | CPT 93307 | $956.73 |
| Stress echocardiogram | CPT 93350 | $3,053.81 |
| Basic metabolic panel (BMP) | CPT 80048 | $102.40 |
| General health panel | CPT 80050 | $226.85 |
| Electrolyte panel | CPT 80051 | $39.00 |
| Comprehensive metabolic panel | CPT 80053 | $24.56 |
| Lipid panel | CPT 80061 | $76.09 |
| Renal function panel | CPT 80069 | $48.97 |
| Hepatic function panel | CPT 80076 | $185.54 |
| Urinalysis non-automated | CPT 81002 | $9.10 |
| Urinalysis automated | CPT 81003 | — |
| Glucose quantitative | CPT 82947 | $66.78 |
| Hemoglobin A1c | CPT 83036 | $55.52 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $100.67 |
| Complete blood count with automated differential | CPT 85025 | $45.63 |
| Complete blood count without differential | CPT 85027 | $86.53 |
| Urine culture bacterial | CPT 87086 | $18.77 |
| Tissue exam by pathologist level IV | CPT 88305 | $426.93 |
| Fetal non-stress test | CPT 59025 | $448.63 |
| Vaginal delivery only | CPT 59409 | $1,606.23 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,704.46 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,924.88 |
| Sigmoidoscopy diagnostic | CPT 45330 | $75.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | — |
| Colonoscopy diagnostic | CPT 45378 | $2,716.74 |
| Colonoscopy with biopsy | CPT 45380 | $2,951.21 |
| Colonoscopy with polyp removal | CPT 45385 | $3,733.94 |
| PCI single major coronary artery | CPT 92920 | — |
| PCI with drug-eluting stent | CPT 92928 | $63.70 |
| PCI bypass graft | CPT 92937 | $9,331.62 |
| Left heart catheterization | CPT 93452 | $75.00 |
| Coronary angiography with cath | CPT 93455 | $75.00 |
| Coronary angiography with bypass cath | CPT 93458 | $9,547.41 |
