| ED visit level 1 | CPT 99281 | $42.92 |
| ED visit level 2 | CPT 99282 | $84.36 |
| ED visit level 3 | CPT 99283 | $122.84 |
| ED visit level 4 | CPT 99284 | $225.70 |
| ED visit level 5 | CPT 99285 | $328.56 |
| Critical care, first hour | CPT 99291 | $1,054.50 |
| CT head without contrast | CPT 70450 | $706.70 |
| CT head with contrast | CPT 70460 | $713.36 |
| CT head with and without contrast | CPT 70470 | $754.06 |
| CT neck with contrast | CPT 70491 | $869.50 |
| Chest X-ray single view | CPT 71045 | $79.92 |
| Chest X-ray 2 views | CPT 71046 | $98.42 |
| Chest X-ray 3 views | CPT 71047 | $93.24 |
| CT chest without contrast | CPT 71250 | $930.92 |
| CT chest with contrast | CPT 71260 | $1,161.06 |
| CT chest with and without contrast | CPT 71270 | $1,460.02 |
| Lumbosacral spine X-ray | CPT 72100 | $128.76 |
| CT cervical spine without contrast | CPT 72125 | $1,049.32 |
| CT thoracic spine without contrast | CPT 72128 | $814.74 |
| CT lumbar spine without contrast | CPT 72131 | $979.76 |
| CT pelvis without contrast | CPT 72192 | $879.12 |
| Shoulder X-ray | CPT 73030 | $118.40 |
| Humerus X-ray | CPT 73060 | $97.68 |
| Hand X-ray 3 views | CPT 73130 | $119.88 |
| Hip X-ray 2 views | CPT 73510 | $82.14 |
| Knee X-ray 1-2 views | CPT 73560 | $116.92 |
| Ankle X-ray 3 views | CPT 73610 | $118.40 |
| CT abdomen without contrast | CPT 74150 | $1,114.44 |
| CT abdomen with contrast | CPT 74160 | $1,105.56 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,033.78 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,746.40 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,004.66 |
| Abdominal ultrasound complete | CPT 76700 | $421.80 |
| Abdominal ultrasound limited | CPT 76705 | $328.56 |
| Retroperitoneal ultrasound complete | CPT 76770 | $372.22 |
| Transvaginal ultrasound | CPT 76830 | $270.84 |
| Pelvic ultrasound complete | CPT 76856 | $349.28 |
| Scrotal ultrasound | CPT 76870 | $324.12 |
| Diagnostic mammography unilateral | CPT 77065 | $325.60 |
| Diagnostic mammography bilateral | CPT 77066 | $416.62 |
| Screening mammography bilateral | CPT 77067 | $444.74 |
| EKG tracing only | CPT 93005 | $98.42 |
| EKG interpretation only | CPT 93010 | $19.24 |
| Transthoracic echocardiogram complete | CPT 93306 | $523.18 |
| Transthoracic echocardiogram | CPT 93307 | $195.36 |
| Initial hospital care, low complexity | CPT 99221 | $111.00 |
| Initial hospital care, moderate complexity | CPT 99222 | $174.64 |
| Hospital discharge, <30 min | CPT 99238 | $136.90 |
| Hospital discharge, >30 min | CPT 99239 | $170.94 |
| Hepatic function panel | CPT 80076 | $66.60 |
| Urinalysis non-automated | CPT 81002 | $14.06 |
| Glucose quantitative | CPT 82947 | $34.04 |
| Vaginal delivery only | CPT 59409 | $2,941.50 |
| Office visit, established patient, 5 min | CPT 99211 | $84.36 |
| Total shoulder arthroplasty | CPT 23472 | $74.00 |
| Total hip replacement | CPT 27130 | $74.00 |
| Total knee replacement | CPT 27447 | $74.00 |
