| ED visit level 1 | CPT 99281 | $251.37 |
| ED visit level 2 | CPT 99282 | $319.01 |
| ED visit level 3 | CPT 99283 | $533.83 |
| ED visit level 4 | CPT 99284 | $1,363.63 |
| ED visit level 5 | CPT 99285 | $2,107.11 |
| Critical care, first hour | CPT 99291 | $1,610 |
| CT head without contrast | CPT 70450 | $1,617.85 |
| CT head with contrast | CPT 70460 | $1,810.07 |
| CT head with and without contrast | CPT 70470 | $2,112.54 |
| CT neck with contrast | CPT 70491 | $2,250.63 |
| MRI brain without contrast | CPT 70551 | $1,380.5 |
| MRI brain with contrast | CPT 70552 | $1,588.03 |
| MRI brain with and without contrast | CPT 70553 | $1,881.08 |
| Chest X-ray single view | CPT 71045 | $653.65 |
| Chest X-ray 2 views | CPT 71046 | $735.6 |
| Chest X-ray 3 views | CPT 71047 | $799.03 |
| CT chest without contrast | CPT 71250 | $1,223.98 |
| CT chest with contrast | CPT 71260 | $1,367.56 |
| CT chest with and without contrast | CPT 71270 | $1,981.9 |
| Lumbosacral spine X-ray | CPT 72100 | $1,156.39 |
| CT cervical spine without contrast | CPT 72125 | $1,799.87 |
| CT thoracic spine without contrast | CPT 72128 | $889.34 |
| CT lumbar spine without contrast | CPT 72131 | $1,340.1 |
| MRI cervical spine without contrast | CPT 72141 | $1,469.95 |
| MRI thoracic spine without contrast | CPT 72146 | $1,254.18 |
| MRI lumbar spine without contrast | CPT 72148 | $1,489.56 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,674.34 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,737.1 |
| MRI lumbar spine with contrast | CPT 72158 | $1,827.33 |
| CT pelvis without contrast | CPT 72192 | $1,267.13 |
| CT pelvis with contrast | CPT 72193 | $1,395.02 |
| Shoulder X-ray | CPT 73030 | $1,316.86 |
| Humerus X-ray | CPT 73060 | $932.6 |
| Hand X-ray 3 views | CPT 73130 | $1,231.05 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,800.43 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,095.67 |
| Knee X-ray 1-2 views | CPT 73560 | $1,173.73 |
| Ankle X-ray 3 views | CPT 73610 | $1,340.98 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,557.4 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,045.45 |
| CT abdomen without contrast | CPT 74150 | $1,194.16 |
| CT abdomen with contrast | CPT 74160 | $1,340.49 |
| CT abdomen with and without contrast | CPT 74170 | $1,674.34 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,888.11 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,276.88 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,610.34 |
| MRI abdomen without contrast | CPT 74181 | $1,363.63 |
| MRI abdomen with and without contrast | CPT 74183 | $1,687.67 |
| Abdominal ultrasound complete | CPT 76700 | $1,924.3 |
| Abdominal ultrasound limited | CPT 76705 | $1,622.89 |
| Retroperitoneal ultrasound complete | CPT 76770 | $1,625.64 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,927.84 |
| Obstetric ultrasound after first trimester | CPT 76805 | $2,599.22 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $296.29 |
| Transvaginal ultrasound | CPT 76830 | $1,434.55 |
| Pelvic ultrasound complete | CPT 76856 | $1,695.38 |
| Scrotal ultrasound | CPT 76870 | $1,575.21 |
| Diagnostic mammography unilateral | CPT 77065 | $632.76 |
| Diagnostic mammography bilateral | CPT 77066 | $843.55 |
| Screening mammography bilateral | CPT 77067 | $766.72 |
| EKG tracing only | CPT 93005 | $205.67 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,274.56 |
| Transthoracic echocardiogram | CPT 93307 | $1,069.71 |
| Stress echocardiogram | CPT 93350 | $1,372.3 |
| Basic metabolic panel (BMP) | CPT 80048 | $122.93 |
| General health panel | CPT 80050 | $340.81 |
| Electrolyte panel | CPT 80051 | $12.61 |
| Comprehensive metabolic panel | CPT 80053 | $167.06 |
| Lipid panel | CPT 80061 | $121.75 |
| Renal function panel | CPT 80069 | $163.51 |
| Hepatic function panel | CPT 80076 | $85.1 |
| Urinalysis non-automated | CPT 81002 | $6.3 |
| Urinalysis automated | CPT 81003 | $58.71 |
| Glucose quantitative | CPT 82947 | $42.95 |
| Hemoglobin A1c | CPT 83036 | $37.36 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $121.35 |
| Complete blood count with automated differential | CPT 85025 | $130.81 |
| Complete blood count without differential | CPT 85027 | $101.65 |
| Urine culture bacterial | CPT 87086 | $102.05 |
| Urine culture identification | CPT 87088 | $13.79 |
| Tissue exam by pathologist level IV | CPT 88305 | $668.22 |
| Fetal non-stress test | CPT 59025 | $295.11 |
| Office visit, established patient, 5 min | CPT 99211 | $280.53 |
| Upper GI endoscopy diagnostic | CPT 43235 | $3,470.35 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,931.73 |
| Sigmoidoscopy diagnostic | CPT 45330 | $914.87 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,870.71 |
| Colonoscopy diagnostic | CPT 45378 | $4,164.58 |
| Colonoscopy with biopsy | CPT 45380 | $5,956.89 |
| Colonoscopy with polyp removal | CPT 45385 | $4,582.22 |
| PCI single major coronary artery | CPT 92920 | $12,630 |
| PCI with drug-eluting stent | CPT 92928 | $12,630 |
| PCI bypass graft | CPT 92937 | $12,630 |
| Left heart catheterization | CPT 93452 | $4,102.33 |
| Coronary angiography with cath | CPT 93455 | $4,387.58 |
| Coronary angiography with bypass cath | CPT 93458 | $8,564.77 |
