| ED visit level 1 | CPT 99281 | $336.72 |
| ED visit level 2 | CPT 99282 | $220.8 |
| ED visit level 3 | CPT 99283 | $324.53 |
| ED visit level 4 | CPT 99284 | $1,421.24 |
| ED visit level 5 | CPT 99285 | $1,898.26 |
| Critical care, first hour | CPT 99291 | $802.47 |
| CT head without contrast | CPT 70450 | $853.94 |
| CT head with contrast | CPT 70460 | $885.64 |
| CT head with and without contrast | CPT 70470 | $940.95 |
| CT neck with contrast | CPT 70491 | $786.07 |
| MRI brain without contrast | CPT 70551 | $995.67 |
| MRI brain with contrast | CPT 70552 | $1,634.63 |
| MRI brain with and without contrast | CPT 70553 | $1,483.94 |
| Chest X-ray single view | CPT 71045 | $262.88 |
| Chest X-ray 2 views | CPT 71046 | $420.36 |
| Chest X-ray 3 views | CPT 71047 | $461.9 |
| CT chest without contrast | CPT 71250 | $958.59 |
| CT chest with contrast | CPT 71260 | $1,108.69 |
| CT chest with and without contrast | CPT 71270 | $1,247.13 |
| Lumbosacral spine X-ray | CPT 72100 | $600.16 |
| CT cervical spine without contrast | CPT 72125 | $1,006.73 |
| CT thoracic spine without contrast | CPT 72128 | $955.6 |
| CT lumbar spine without contrast | CPT 72131 | $990.89 |
| MRI cervical spine without contrast | CPT 72141 | $1,378.69 |
| MRI thoracic spine without contrast | CPT 72146 | $1,307.23 |
| MRI lumbar spine without contrast | CPT 72148 | $1,360.45 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,624.17 |
| MRI lumbar spine with contrast | CPT 72158 | $1,744.07 |
| CT pelvis without contrast | CPT 72192 | $925.7 |
| CT pelvis with contrast | CPT 72193 | $1,017.8 |
| Shoulder X-ray | CPT 73030 | $832.35 |
| Humerus X-ray | CPT 73060 | $564.2 |
| Hand X-ray 3 views | CPT 73130 | $940.23 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,210.21 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,792.51 |
| Knee X-ray 1-2 views | CPT 73560 | $898.38 |
| Ankle X-ray 3 views | CPT 73610 | $950.46 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,873.83 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,785.93 |
| CT abdomen without contrast | CPT 74150 | $911.95 |
| CT abdomen with contrast | CPT 74160 | $1,003.15 |
| CT abdomen with and without contrast | CPT 74170 | $1,325.47 |
| CT abdomen and pelvis without contrast | CPT 74176 | $914.94 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,365.53 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,989.85 |
| MRI abdomen without contrast | CPT 74181 | $1,381.08 |
| MRI abdomen with and without contrast | CPT 74183 | $1,671.41 |
| Abdominal ultrasound complete | CPT 76700 | $784.49 |
| Abdominal ultrasound limited | CPT 76705 | $591.77 |
| Retroperitoneal ultrasound complete | CPT 76770 | $705.03 |
| Obstetric ultrasound first trimester | CPT 76801 | $794.22 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,025.48 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $256.06 |
| Transvaginal ultrasound | CPT 76830 | $724.16 |
| Pelvic ultrasound complete | CPT 76856 | $650.16 |
| Scrotal ultrasound | CPT 76870 | $607.14 |
| Diagnostic mammography unilateral | CPT 77065 | $288.29 |
| Diagnostic mammography bilateral | CPT 77066 | $395.01 |
| Screening mammography bilateral | CPT 77067 | $343.73 |
| EKG tracing only | CPT 93005 | $316.82 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,406.78 |
| Stress echocardiogram | CPT 93350 | $1,009.98 |
| Basic metabolic panel (BMP) | CPT 80048 | $327.6 |
| General health panel | CPT 80050 | $1,453.9 |
| Electrolyte panel | CPT 80051 | $31.57 |
| Comprehensive metabolic panel | CPT 80053 | $406.17 |
| Lipid panel | CPT 80061 | $412.48 |
| Renal function panel | CPT 80069 | $326.2 |
| Hepatic function panel | CPT 80076 | $249.74 |
| Urinalysis non-automated | CPT 81002 | $9.82 |
| Urinalysis automated | CPT 81003 | $120.66 |
| Glucose quantitative | CPT 82947 | $74.36 |
| Hemoglobin A1c | CPT 83036 | $36.25 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $185.9 |
| Complete blood count with automated differential | CPT 85025 | $331.81 |
| Complete blood count without differential | CPT 85027 | $148.02 |
| Urine culture bacterial | CPT 87086 | $179.59 |
| Urine culture identification | CPT 87088 | $25.96 |
| Tissue exam by pathologist level IV | CPT 88305 | $289.02 |
| Fetal non-stress test | CPT 59025 | $554.9 |
| Office visit, established patient, 5 min | CPT 99211 | $239.73 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,633.27 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,803.93 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,076.29 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,418.59 |
| Colonoscopy diagnostic | CPT 45378 | $2,377.03 |
| Colonoscopy with biopsy | CPT 45380 | $2,594.63 |
| Colonoscopy with polyp removal | CPT 45385 | $2,820.06 |
