| ED visit level 1 | CPT 99281 | $112.34 |
| ED visit level 2 | CPT 99282 | $159.90 |
| ED visit level 3 | CPT 99283 | $732.26 |
| ED visit level 4 | CPT 99284 | $1,171.37 |
| ED visit level 5 | CPT 99285 | $1,841.31 |
| Critical care, first hour | CPT 99291 | $2,935.60 |
| CT head without contrast | CPT 70450 | $1,692.50 |
| CT head with contrast | CPT 70460 | $2,063.50 |
| CT head with and without contrast | CPT 70470 | $2,485.50 |
| CT neck with contrast | CPT 70491 | $2,051.00 |
| MRI brain without contrast | CPT 70551 | $1,655.00 |
| MRI brain with contrast | CPT 70552 | $2,705.00 |
| MRI brain with and without contrast | CPT 70553 | $3,314.50 |
| Chest X-ray single view | CPT 71045 | $372.60 |
| Chest X-ray 2 views | CPT 71046 | $496.80 |
| Chest X-ray 3 views | CPT 71047 | $612.90 |
| CT chest without contrast | CPT 71250 | $1,782.00 |
| CT chest with contrast | CPT 71260 | $2,114.00 |
| CT chest with and without contrast | CPT 71270 | $2,439.50 |
| MRI chest without contrast | CPT 71550 | $2,095.50 |
| MRI chest with and without contrast | CPT 71552 | $2,357.00 |
| Lumbosacral spine X-ray | CPT 72100 | $756.90 |
| CT cervical spine without contrast | CPT 72125 | $2,064.50 |
| CT thoracic spine without contrast | CPT 72128 | $1,316.00 |
| CT lumbar spine without contrast | CPT 72131 | $1,319.50 |
| MRI cervical spine without contrast | CPT 72141 | $1,501.00 |
| MRI thoracic spine without contrast | CPT 72146 | $1,575.00 |
| MRI lumbar spine without contrast | CPT 72148 | $1,633.00 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,460.00 |
| MRI lumbar spine with contrast | CPT 72158 | $2,481.50 |
| CT pelvis without contrast | CPT 72192 | $1,415.50 |
| CT pelvis with contrast | CPT 72193 | $2,203.50 |
| Shoulder X-ray | CPT 73030 | $1,007.10 |
| Humerus X-ray | CPT 73060 | $984.15 |
| Hand X-ray 3 views | CPT 73130 | $869.40 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,886.00 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,281.00 |
| Knee X-ray 1-2 views | CPT 73560 | $872.10 |
| Ankle X-ray 3 views | CPT 73610 | $961.20 |
| MRI lower extremity joint without contrast | CPT 73721 | $3,000.00 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,478.50 |
| CT abdomen without contrast | CPT 74150 | $1,901.00 |
| CT abdomen with contrast | CPT 74160 | $1,539.50 |
| CT abdomen with and without contrast | CPT 74170 | $2,660.50 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,786.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $4,402.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,350.50 |
| MRI abdomen without contrast | CPT 74181 | $1,980.00 |
| MRI abdomen with and without contrast | CPT 74183 | $2,117.50 |
| Abdominal ultrasound complete | CPT 76700 | $531.50 |
| Abdominal ultrasound limited | CPT 76705 | $628.50 |
| Retroperitoneal ultrasound complete | CPT 76770 | $669.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,090.80 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,047.60 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,257.30 |
| Transvaginal ultrasound | CPT 76830 | $979.20 |
| Pelvic ultrasound complete | CPT 76856 | $615.00 |
| Scrotal ultrasound | CPT 76870 | $408.50 |
| Diagnostic mammography unilateral | CPT 77065 | $555.30 |
| Diagnostic mammography bilateral | CPT 77066 | $656.10 |
| Screening mammography bilateral | CPT 77067 | $504.90 |
| EKG tracing only | CPT 93005 | $543.60 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,074.50 |
| Stress echocardiogram | CPT 93350 | $1,566.90 |
| Basic metabolic panel (BMP) | CPT 80048 | $464.40 |
| General health panel | CPT 80050 | $441.90 |
| Electrolyte panel | CPT 80051 | $330.30 |
| Comprehensive metabolic panel | CPT 80053 | $596.70 |
| Lipid panel | CPT 80061 | $296.10 |
| Renal function panel | CPT 80069 | $463.50 |
| Hepatic function panel | CPT 80076 | $514.80 |
| Urinalysis non-automated | CPT 81002 | $38.70 |
| Urinalysis automated | CPT 81003 | $72.90 |
| Glucose quantitative | CPT 82947 | $279.90 |
| Hemoglobin A1c | CPT 83036 | $166.50 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $422.10 |
| Complete blood count with automated differential | CPT 85025 | $280.80 |
| Complete blood count without differential | CPT 85027 | $142.20 |
| Urine culture bacterial | CPT 87086 | $373.50 |
| Tissue exam by pathologist level IV | CPT 88305 | $603.90 |
| Fetal non-stress test | CPT 59025 | $778.59 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,450.00 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,278.00 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,608.50 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,909.00 |
| Colonoscopy diagnostic | CPT 45378 | $1,839.00 |
| Colonoscopy with biopsy | CPT 45380 | $2,008.50 |
| Colonoscopy with polyp removal | CPT 45385 | $2,022.50 |
