| ED visit level 1 | CPT 99281 | $125.00 |
| ED visit level 2 | CPT 99282 | $208.00 |
| ED visit level 3 | CPT 99283 | $324.00 |
| ED visit level 4 | CPT 99284 | $483.00 |
| ED visit level 5 | CPT 99285 | $592.00 |
| Critical care, first hour | CPT 99291 | $941.00 |
| CT head without contrast | CPT 70450 | $1,260.00 |
| CT head with contrast | CPT 70460 | $1,375.00 |
| CT head with and without contrast | CPT 70470 | $1,396.00 |
| CT neck with contrast | CPT 70491 | $1,538.00 |
| MRI brain without contrast | CPT 70551 | $2,227.00 |
| MRI brain with contrast | CPT 70552 | $2,295.00 |
| MRI brain with and without contrast | CPT 70553 | $2,369.00 |
| Chest X-ray single view | CPT 71045 | $171.00 |
| Chest X-ray 2 views | CPT 71046 | $214.00 |
| CT chest without contrast | CPT 71250 | $1,424.00 |
| CT chest with contrast | CPT 71260 | $1,641.00 |
| CT chest with and without contrast | CPT 71270 | $1,847.00 |
| MRI chest without contrast | CPT 71550 | $1,546.00 |
| MRI chest with contrast | CPT 71551 | $1,750.00 |
| MRI chest with and without contrast | CPT 71552 | $2,253.00 |
| Lumbosacral spine X-ray | CPT 72100 | $262.00 |
| CT cervical spine without contrast | CPT 72125 | $1,545.00 |
| CT thoracic spine without contrast | CPT 72128 | $1,512.00 |
| CT lumbar spine without contrast | CPT 72131 | $1,512.00 |
| MRI cervical spine without contrast | CPT 72141 | $2,170.00 |
| MRI thoracic spine without contrast | CPT 72146 | $2,118.00 |
| MRI lumbar spine without contrast | CPT 72148 | $2,086.00 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,950.00 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,624.00 |
| MRI lumbar spine with contrast | CPT 72158 | $2,472.00 |
| CT pelvis without contrast | CPT 72192 | $1,405.00 |
| CT pelvis with contrast | CPT 72193 | $1,667.00 |
| Shoulder X-ray | CPT 73030 | $219.00 |
| Humerus X-ray | CPT 73060 | $187.00 |
| Hand X-ray 3 views | CPT 73130 | $204.00 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,614.00 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,326.00 |
| Knee X-ray 1-2 views | CPT 73560 | $256.00 |
| Ankle X-ray 3 views | CPT 73610 | $277.00 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,624.00 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,266.00 |
| CT abdomen without contrast | CPT 74150 | $1,401.00 |
| CT abdomen with contrast | CPT 74160 | $1,673.00 |
| CT abdomen with and without contrast | CPT 74170 | $1,807.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,458.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,871.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,408.00 |
| MRI abdomen without contrast | CPT 74181 | $2,015.00 |
| MRI abdomen with and without contrast | CPT 74183 | $2,647.00 |
| Abdominal ultrasound complete | CPT 76700 | $539.00 |
| Abdominal ultrasound limited | CPT 76705 | $426.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $511.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $408.00 |
| Obstetric ultrasound after first trimester | CPT 76805 | $451.00 |
| Transvaginal ultrasound | CPT 76830 | $392.00 |
| Pelvic ultrasound complete | CPT 76856 | $506.00 |
| Scrotal ultrasound | CPT 76870 | $425.00 |
| EKG complete | CPT 93000 | $47.00 |
| EKG tracing only | CPT 93005 | $26.00 |
| EKG interpretation only | CPT 93010 | $24.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,371.00 |
| Transthoracic echocardiogram | CPT 93307 | $1,123.00 |
| Stress echocardiogram | CPT 93350 | $936.00 |
| Initial hospital care, low complexity | CPT 99221 | $138.00 |
| Initial hospital care, moderate complexity | CPT 99222 | $191.00 |
| Initial hospital care, high complexity | CPT 99223 | $277.00 |
| Hospital discharge, <30 min | CPT 99238 | $131.00 |
| Hospital discharge, >30 min | CPT 99239 | $148.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $73.00 |
| General health panel | CPT 80050 | $91.00 |
| Electrolyte panel | CPT 80051 | $70.00 |
| Comprehensive metabolic panel | CPT 80053 | $120.50 |
| Lipid panel | CPT 80061 | $80.00 |
| Renal function panel | CPT 80069 | $123.00 |
| Hepatic function panel | CPT 80076 | $70.50 |
| Urinalysis non-automated | CPT 81002 | $19.00 |
| Urinalysis automated | CPT 81003 | $19.00 |
| Glucose quantitative | CPT 82947 | $18.00 |
| Hemoglobin A1c | CPT 83036 | $53.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $78.00 |
| Complete blood count with automated differential | CPT 85025 | $48.00 |
| Complete blood count without differential | CPT 85027 | $50.00 |
| Urine culture bacterial | CPT 87086 | $58.00 |
| Urine culture identification | CPT 87088 | $73.00 |
| Tissue exam by pathologist level IV | CPT 88305 | $125.00 |
| Routine obstetric care with C-section | CPT 59510 | $3,205.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $92.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $133.00 |
| Office visit, new patient, 45-59 min | CPT 99204 | $223.00 |
| Office visit, new patient, 60-74 min | CPT 99205 | $281.00 |
| Office visit, established patient, 5 min | CPT 99211 | $60.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $50.00 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $96.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $140.00 |
| Office visit, established patient, 40-54 min | CPT 99215 | $198.00 |
| Open umbilical hernia repair | CPT 49560 | $1,206.00 |
| Umbilical hernia repair age 5+ | CPT 49585 | $732.00 |
