| ED visit level 1 | CPT 99281 | $110.29 |
| ED visit level 2 | CPT 99282 | $157.03 |
| ED visit level 3 | CPT 99283 | $718.32 |
| ED visit level 4 | CPT 99284 | $1,149.23 |
| ED visit level 5 | CPT 99285 | $1,806.46 |
| Critical care, first hour | CPT 99291 | $2,880.66 |
| CT head without contrast | CPT 70450 | $1,661.00 |
| CT head with contrast | CPT 70460 | $2,024.50 |
| CT head with and without contrast | CPT 70470 | $2,439.00 |
| CT neck with contrast | CPT 70491 | $2,012.50 |
| MRI brain without contrast | CPT 70551 | $1,624.00 |
| MRI brain with contrast | CPT 70552 | $3,317.50 |
| MRI brain with and without contrast | CPT 70553 | $3,252.00 |
| Chest X-ray single view | CPT 71045 | $365.40 |
| Chest X-ray 2 views | CPT 71046 | $486.90 |
| Chest X-ray 3 views | CPT 71047 | $601.20 |
| CT chest without contrast | CPT 71250 | $1,748.50 |
| CT chest with contrast | CPT 71260 | $2,074.50 |
| CT chest with and without contrast | CPT 71270 | $2,393.00 |
| MRI chest without contrast | CPT 71550 | $2,055.50 |
| MRI chest with and without contrast | CPT 71552 | $2,313.00 |
| Lumbosacral spine X-ray | CPT 72100 | $743.40 |
| CT cervical spine without contrast | CPT 72125 | $2,025.50 |
| CT thoracic spine without contrast | CPT 72128 | $1,844.00 |
| CT lumbar spine without contrast | CPT 72131 | $1,850.00 |
| MRI cervical spine without contrast | CPT 72141 | $1,963.50 |
| MRI thoracic spine without contrast | CPT 72146 | $2,061.00 |
| MRI lumbar spine without contrast | CPT 72148 | $2,136.50 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,218.50 |
| MRI lumbar spine with contrast | CPT 72158 | $3,246.50 |
| CT pelvis without contrast | CPT 72192 | $1,851.50 |
| CT pelvis with contrast | CPT 72193 | $2,162.00 |
| Shoulder X-ray | CPT 73030 | $986.85 |
| Humerus X-ray | CPT 73060 | $642.60 |
| Hand X-ray 3 views | CPT 73130 | $854.55 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,137.88 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,238.50 |
| Knee X-ray 1-2 views | CPT 73560 | $855.90 |
| Ankle X-ray 3 views | CPT 73610 | $942.30 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,943.75 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,413.25 |
| CT abdomen without contrast | CPT 74150 | $1,865.00 |
| CT abdomen with contrast | CPT 74160 | $2,157.50 |
| CT abdomen with and without contrast | CPT 74170 | $2,610.50 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,715.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $4,319.50 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,249.50 |
| MRI abdomen without contrast | CPT 74181 | $1,942.00 |
| MRI abdomen with and without contrast | CPT 74183 | $2,078.00 |
| Abdominal ultrasound complete | CPT 76700 | $744.50 |
| Abdominal ultrasound limited | CPT 76705 | $616.50 |
| Retroperitoneal ultrasound complete | CPT 76770 | $656.50 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,070.10 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,027.80 |
| Transvaginal ultrasound | CPT 76830 | $960.30 |
| Pelvic ultrasound complete | CPT 76856 | $603.50 |
| Scrotal ultrasound | CPT 76870 | $573.00 |
| Screening mammography bilateral | CPT 77067 | $495.90 |
| EKG tracing only | CPT 93005 | $533.70 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,034.90 |
| Transthoracic echocardiogram | CPT 93307 | $1,049.40 |
| Stress echocardiogram | CPT 93350 | $2,196.90 |
| Basic metabolic panel (BMP) | CPT 80048 | $456.30 |
| General health panel | CPT 80050 | $433.50 |
| Electrolyte panel | CPT 80051 | $324.90 |
| Comprehensive metabolic panel | CPT 80053 | $585.00 |
| Lipid panel | CPT 80061 | $414.90 |
| Renal function panel | CPT 80069 | $453.60 |
| Hepatic function panel | CPT 80076 | $504.90 |
| Urinalysis non-automated | CPT 81002 | $37.80 |
| Urinalysis automated | CPT 81003 | $71.10 |
| Glucose quantitative | CPT 82947 | $274.50 |
| Hemoglobin A1c | CPT 83036 | $234.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $413.10 |
| Complete blood count with automated differential | CPT 85025 | $275.40 |
| Complete blood count without differential | CPT 85027 | $140.40 |
| Urine culture bacterial | CPT 87086 | $366.30 |
| Tissue exam by pathologist level IV | CPT 88305 | $810.90 |
| Office visit, established patient, 5 min | CPT 99211 | $500.40 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,032.50 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,235.00 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,578.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,854.00 |
| Colonoscopy diagnostic | CPT 45378 | $1,804.00 |
| Colonoscopy with biopsy | CPT 45380 | $1,984.50 |
| Colonoscopy with polyp removal | CPT 45385 | $1,984.50 |
| PCI single major coronary artery | CPT 92920 | $13,851 |
| PCI with drug-eluting stent | CPT 92928 | $9,582.93 |
| PCI bypass graft | CPT 92937 | $9,582.93 |
| Left heart catheterization | CPT 93452 | $16,004 |
| Coronary angiography with cath | CPT 93455 | $20,383 |
| Coronary angiography with bypass cath | CPT 93458 | $26,011 |
