| ED visit level 1 | CPT 99281 | $377.65 |
| ED visit level 2 | CPT 99282 | $225.86 |
| ED visit level 3 | CPT 99283 | $371.91 |
| ED visit level 4 | CPT 99284 | $1,892.15 |
| ED visit level 5 | CPT 99285 | $2,934.75 |
| Critical care, first hour | CPT 99291 | $706.33 |
| CT head without contrast | CPT 70450 | $1,683.5 |
| CT head with contrast | CPT 70460 | $2,413.45 |
| CT head with and without contrast | CPT 70470 | $2,290.6 |
| CT neck with contrast | CPT 70491 | $2,037.75 |
| MRI brain without contrast | CPT 70551 | $2,847.65 |
| MRI brain with contrast | CPT 70552 | $2,903.55 |
| MRI brain with and without contrast | CPT 70553 | $3,129.1 |
| Chest X-ray single view | CPT 71045 | $315.65 |
| Chest X-ray 2 views | CPT 71046 | $315.65 |
| Chest X-ray 3 views | CPT 71047 | $389.48 |
| CT chest without contrast | CPT 71250 | $3,308.5 |
| CT chest with contrast | CPT 71260 | $2,820.35 |
| CT chest with and without contrast | CPT 71270 | $2,801.5 |
| MRI chest without contrast | CPT 71550 | $1,502.8 |
| Lumbosacral spine X-ray | CPT 72100 | $321 |
| CT cervical spine without contrast | CPT 72125 | $2,540.85 |
| CT thoracic spine without contrast | CPT 72128 | $3,191.5 |
| CT lumbar spine without contrast | CPT 72131 | $2,444 |
| MRI cervical spine without contrast | CPT 72141 | $2,763.15 |
| MRI thoracic spine without contrast | CPT 72146 | $2,208.7 |
| MRI lumbar spine without contrast | CPT 72148 | $1,604.2 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,650.05 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,342.95 |
| MRI lumbar spine with contrast | CPT 72158 | $3,056.95 |
| CT pelvis without contrast | CPT 72192 | $1,503.45 |
| CT pelvis with contrast | CPT 72193 | $2,759.9 |
| Shoulder X-ray | CPT 73030 | $487.12 |
| Humerus X-ray | CPT 73060 | $595.46 |
| Hand X-ray 3 views | CPT 73130 | $680.52 |
| MRI upper extremity joint without contrast | CPT 73221 | $5,453.18 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,399.2 |
| Knee X-ray 1-2 views | CPT 73560 | $350.7 |
| Ankle X-ray 3 views | CPT 73610 | $547.31 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,925.98 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,360.15 |
| CT abdomen without contrast | CPT 74150 | $2,650.7 |
| CT abdomen with contrast | CPT 74160 | $2,041.65 |
| CT abdomen with and without contrast | CPT 74170 | $3,207.75 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,635.45 |
| CT abdomen and pelvis with contrast | CPT 74177 | $6,399.25 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $8,797.75 |
| MRI abdomen without contrast | CPT 74181 | $2,085.2 |
| MRI abdomen with and without contrast | CPT 74183 | $2,523.95 |
| Abdominal ultrasound complete | CPT 76700 | $980.12 |
| Abdominal ultrasound limited | CPT 76705 | $1,012.22 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,138.48 |
| Obstetric ultrasound first trimester | CPT 76801 | $519.49 |
| Obstetric ultrasound after first trimester | CPT 76805 | $708.88 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,023.46 |
| Transvaginal ultrasound | CPT 76830 | $635.05 |
| Pelvic ultrasound complete | CPT 76856 | $1,118.15 |
| Scrotal ultrasound | CPT 76870 | $1,026.67 |
| Diagnostic mammography unilateral | CPT 77065 | $476.45 |
| Diagnostic mammography bilateral | CPT 77066 | $635.05 |
| Screening mammography bilateral | CPT 77067 | $577.2 |
| EKG tracing only | CPT 93005 | $229.52 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,860.73 |
| Transthoracic echocardiogram | CPT 93307 | $858.68 |
| Basic metabolic panel (BMP) | CPT 80048 | $148.2 |
| General health panel | CPT 80050 | $543.74 |
| Electrolyte panel | CPT 80051 | $174.2 |
| Comprehensive metabolic panel | CPT 80053 | $114.4 |
| Lipid panel | CPT 80061 | $232.05 |
| Renal function panel | CPT 80069 | $229.45 |
| Hepatic function panel | CPT 80076 | $140.4 |
| Urinalysis non-automated | CPT 81002 | $10.4 |
| Urinalysis automated | CPT 81003 | $70.2 |
| Glucose quantitative | CPT 82947 | $81.9 |
| Hemoglobin A1c | CPT 83036 | $35 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $374.4 |
| Complete blood count with automated differential | CPT 85025 | $155.35 |
| Complete blood count without differential | CPT 85027 | $115.7 |
| Urine culture bacterial | CPT 87086 | $104.65 |
| Tissue exam by pathologist level IV | CPT 88305 | $878.8 |
| Office visit, established patient, 5 min | CPT 99211 | $320.4 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,556.45 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,897.05 |
| Sigmoidoscopy diagnostic | CPT 45330 | $809.25 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,655.55 |
| Colonoscopy diagnostic | CPT 45378 | $2,579.2 |
| Colonoscopy with biopsy | CPT 45380 | $2,837.9 |
| Colonoscopy with polyp removal | CPT 45385 | $2,027.35 |
