| ED visit level 3 | CPT 99283 | $766.70 |
| ED visit level 4 | CPT 99284 | $1,227.13 |
| ED visit level 5 | CPT 99285 | $1,929.05 |
| CT head without contrast | CPT 70450 | $2,039.00 |
| CT head with contrast | CPT 70460 | $2,161.50 |
| CT head with and without contrast | CPT 70470 | $3,125.00 |
| CT neck with contrast | CPT 70491 | $2,148.50 |
| MRI brain without contrast | CPT 70551 | $1,734.00 |
| MRI brain with contrast | CPT 70552 | $2,833.50 |
| MRI brain with and without contrast | CPT 70553 | $4,166.50 |
| Chest X-ray single view | CPT 71045 | $292.50 |
| Chest X-ray 2 views | CPT 71046 | $519.30 |
| CT chest without contrast | CPT 71250 | $1,307.00 |
| CT chest with contrast | CPT 71260 | $2,214.50 |
| CT chest with and without contrast | CPT 71270 | $2,555.50 |
| MRI chest without contrast | CPT 71550 | $2,195.00 |
| MRI chest with and without contrast | CPT 71552 | $2,469.50 |
| Lumbosacral spine X-ray | CPT 72100 | $792.90 |
| CT cervical spine without contrast | CPT 72125 | $2,163.00 |
| CT thoracic spine without contrast | CPT 72128 | $1,969.00 |
| CT lumbar spine without contrast | CPT 72131 | $1,975.00 |
| MRI cervical spine without contrast | CPT 72141 | $2,097.00 |
| MRI thoracic spine without contrast | CPT 72146 | $2,200.50 |
| MRI lumbar spine without contrast | CPT 72148 | $2,281.00 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,436.00 |
| MRI lumbar spine with contrast | CPT 72158 | $3,466.00 |
| CT pelvis without contrast | CPT 72192 | $1,976.50 |
| CT pelvis with contrast | CPT 72193 | $2,308.50 |
| Shoulder X-ray | CPT 73030 | $702.90 |
| Humerus X-ray | CPT 73060 | $686.70 |
| Hand X-ray 3 views | CPT 73130 | $607.50 |
| MRI upper extremity joint without contrast | CPT 73221 | $3,023.25 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,389.50 |
| Knee X-ray 1-2 views | CPT 73560 | $913.95 |
| Ankle X-ray 3 views | CPT 73610 | $1,007.10 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,095.50 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,429.00 |
| CT abdomen without contrast | CPT 74150 | $1,991.50 |
| CT abdomen with contrast | CPT 74160 | $2,303.50 |
| CT abdomen with and without contrast | CPT 74170 | $2,787.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,776.50 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,228.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $5,605.00 |
| MRI abdomen without contrast | CPT 74181 | $2,073.50 |
| MRI abdomen with and without contrast | CPT 74183 | $2,218.50 |
| Abdominal ultrasound complete | CPT 76700 | $795.00 |
| Abdominal ultrasound limited | CPT 76705 | $658.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $701.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,142.10 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,097.10 |
| Transvaginal ultrasound | CPT 76830 | $1,026.00 |
| Pelvic ultrasound complete | CPT 76856 | $644.00 |
| Scrotal ultrasound | CPT 76870 | $612.00 |
| EKG tracing only | CPT 93005 | $568.80 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,172.60 |
| Stress echocardiogram | CPT 93350 | $2,345.40 |
| Basic metabolic panel (BMP) | CPT 80048 | $364.50 |
| General health panel | CPT 80050 | $462.90 |
| Electrolyte panel | CPT 80051 | $346.50 |
| Comprehensive metabolic panel | CPT 80053 | $625.50 |
| Lipid panel | CPT 80061 | $442.80 |
| Renal function panel | CPT 80069 | $339.30 |
| Hepatic function panel | CPT 80076 | $539.10 |
| Urinalysis non-automated | CPT 81002 | $40.50 |
| Urinalysis automated | CPT 81003 | $76.50 |
| Glucose quantitative | CPT 82947 | $293.40 |
| Hemoglobin A1c | CPT 83036 | $249.30 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $441.90 |
| Complete blood count with automated differential | CPT 85025 | $294.30 |
| Complete blood count without differential | CPT 85027 | $149.40 |
| Urine culture bacterial | CPT 87086 | $390.60 |
| Tissue exam by pathologist level IV | CPT 88305 | $866.70 |
| Office visit, established patient, 5 min | CPT 99211 | $801.90 |
