| ED visit level 1 | CPT 99281 | $325.13 |
| ED visit level 2 | CPT 99282 | $417.79 |
| ED visit level 3 | CPT 99283 | $728.98 |
| ED visit level 4 | CPT 99284 | $982.77 |
| ED visit level 5 | CPT 99285 | $1,177.11 |
| Critical care, first hour | CPT 99291 | $1,248.04 |
| CT head without contrast | CPT 70450 | $3,042.33 |
| CT head with contrast | CPT 70460 | $3,195.28 |
| CT head with and without contrast | CPT 70470 | $3,483.35 |
| CT neck with contrast | CPT 70491 | $1,900.38 |
| MRI brain without contrast | CPT 70551 | $3,333.85 |
| MRI brain with contrast | CPT 70552 | $3,432.75 |
| MRI brain with and without contrast | CPT 70553 | $4,545.38 |
| Chest X-ray single view | CPT 71045 | $640.80 |
| Chest X-ray 2 views | CPT 71046 | $682.20 |
| Chest X-ray 3 views | CPT 71047 | $750.60 |
| CT chest without contrast | CPT 71250 | $2,897.43 |
| CT chest with contrast | CPT 71260 | $1,664.05 |
| CT chest with and without contrast | CPT 71270 | $1,738.80 |
| MRI chest without contrast | CPT 71550 | $2,159.13 |
| Lumbosacral spine X-ray | CPT 72100 | $665.10 |
| CT cervical spine without contrast | CPT 72125 | $5,285.98 |
| CT thoracic spine without contrast | CPT 72128 | $2,602.45 |
| CT lumbar spine without contrast | CPT 72131 | $2,990.00 |
| MRI cervical spine without contrast | CPT 72141 | $5,474.00 |
| MRI thoracic spine without contrast | CPT 72146 | $5,442.95 |
| MRI lumbar spine without contrast | CPT 72148 | $4,170.48 |
| MRI cervical spine with and without contrast | CPT 72156 | $6,622.85 |
| MRI lumbar spine with contrast | CPT 72158 | $5,653.40 |
| CT pelvis without contrast | CPT 72192 | $4,252.70 |
| CT pelvis with contrast | CPT 72193 | $4,466.03 |
| Shoulder X-ray | CPT 73030 | $795.15 |
| Humerus X-ray | CPT 73060 | $1,117.80 |
| Hand X-ray 3 views | CPT 73130 | $843.75 |
| MRI upper extremity joint without contrast | CPT 73221 | $7,627.09 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,731.10 |
| Knee X-ray 1-2 views | CPT 73560 | $1,421.55 |
| Ankle X-ray 3 views | CPT 73610 | $1,216.35 |
| MRI lower extremity joint without contrast | CPT 73721 | $5,867.59 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $4,751.80 |
| CT abdomen without contrast | CPT 74150 | $5,358.43 |
| CT abdomen with contrast | CPT 74160 | $6,226.68 |
| CT abdomen with and without contrast | CPT 74170 | $7,825.75 |
| CT abdomen and pelvis without contrast | CPT 74176 | $5,358.43 |
| CT abdomen and pelvis with contrast | CPT 74177 | $5,127.85 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $10,173 |
| MRI abdomen without contrast | CPT 74181 | $3,129.73 |
| MRI abdomen with and without contrast | CPT 74183 | $5,280.80 |
| Abdominal ultrasound complete | CPT 76700 | $1,433.48 |
| Abdominal ultrasound limited | CPT 76705 | $1,005.10 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,569.18 |
| Obstetric ultrasound first trimester | CPT 76801 | $534.60 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,548.00 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,453.50 |
| Transvaginal ultrasound | CPT 76830 | $1,822.50 |
| Pelvic ultrasound complete | CPT 76856 | $1,169.55 |
| Scrotal ultrasound | CPT 76870 | $1,294.33 |
| Diagnostic mammography unilateral | CPT 77065 | $555.30 |
| Diagnostic mammography bilateral | CPT 77066 | $852.30 |
| Screening mammography bilateral | CPT 77067 | $656.10 |
| EKG tracing only | CPT 93005 | $566.10 |
| Transthoracic echocardiogram complete | CPT 93306 | $4,566.60 |
| Transthoracic echocardiogram | CPT 93307 | $1,070.10 |
| Basic metabolic panel (BMP) | CPT 80048 | $279.00 |
| General health panel | CPT 80050 | $1,038.60 |
| Electrolyte panel | CPT 80051 | $200.70 |
| Comprehensive metabolic panel | CPT 80053 | $292.50 |
| Lipid panel | CPT 80061 | $346.50 |
| Renal function panel | CPT 80069 | $291.60 |
| Hepatic function panel | CPT 80076 | $446.40 |
| Urinalysis non-automated | CPT 81002 | $27.90 |
| Urinalysis automated | CPT 81003 | $23.40 |
| Glucose quantitative | CPT 82947 | $136.80 |
| Hemoglobin A1c | CPT 83036 | $239.40 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $846.00 |
| Complete blood count with automated differential | CPT 85025 | $295.20 |
| Complete blood count without differential | CPT 85027 | $363.60 |
| Urine culture bacterial | CPT 87086 | $197.10 |
| Tissue exam by pathologist level IV | CPT 88305 | $826.20 |
| Fetal non-stress test | CPT 59025 | $1,562.00 |
| Office visit, established patient, 5 min | CPT 99211 | $844.20 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,857.75 |
| Upper GI endoscopy with biopsy | CPT 43239 | $4,245.15 |
| Sigmoidoscopy diagnostic | CPT 45330 | $855.00 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,111.50 |
| Colonoscopy diagnostic | CPT 45378 | $5,056.35 |
| Colonoscopy with biopsy | CPT 45380 | $6,494.80 |
| Colonoscopy with polyp removal | CPT 45385 | $6,494.80 |
| PCI single major coronary artery | CPT 92920 | $24,390 |
| PCI with drug-eluting stent | CPT 92928 | $18,563 |
| Left heart catheterization | CPT 93452 | $27,554 |
| Coronary angiography with bypass cath | CPT 93458 | $34,443 |
