| ED visit level 1 | CPT 99281 | $444 |
| ED visit level 2 | CPT 99282 | $255.07 |
| ED visit level 3 | CPT 99283 | $380.19 |
| ED visit level 4 | CPT 99284 | $1,901.6 |
| ED visit level 5 | CPT 99285 | $2,441.6 |
| Critical care, first hour | CPT 99291 | $945.53 |
| CT head without contrast | CPT 70450 | $2,076.71 |
| CT head with contrast | CPT 70460 | $418.15 |
| CT head with and without contrast | CPT 70470 | $2,716.77 |
| CT neck with contrast | CPT 70491 | $2,250.15 |
| MRI brain without contrast | CPT 70551 | $2,058.02 |
| MRI brain with contrast | CPT 70552 | $2,271.18 |
| MRI brain with and without contrast | CPT 70553 | $2,744.22 |
| Chest X-ray single view | CPT 71045 | $314.4 |
| Chest X-ray 2 views | CPT 71046 | $472 |
| Chest X-ray 3 views | CPT 71047 | $519.2 |
| CT chest without contrast | CPT 71250 | $1,902.67 |
| CT chest with contrast | CPT 71260 | $2,329.58 |
| CT chest with and without contrast | CPT 71270 | $2,700.42 |
| Lumbosacral spine X-ray | CPT 72100 | $880.8 |
| CT cervical spine without contrast | CPT 72125 | $2,052.18 |
| CT thoracic spine without contrast | CPT 72128 | $1,759.01 |
| CT lumbar spine without contrast | CPT 72131 | $2,035.83 |
| MRI cervical spine without contrast | CPT 72141 | $2,310.89 |
| MRI thoracic spine without contrast | CPT 72146 | $3,072.43 |
| MRI lumbar spine without contrast | CPT 72148 | $3,005.27 |
| MRI lumbar spine with and without contrast | CPT 72149 | $3,306.03 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,510.43 |
| MRI lumbar spine with contrast | CPT 72158 | $3,376.11 |
| CT pelvis without contrast | CPT 72192 | $1,305.24 |
| CT pelvis with contrast | CPT 72193 | $1,928.95 |
| Shoulder X-ray | CPT 73030 | $1,113.6 |
| Humerus X-ray | CPT 73060 | $1,057.2 |
| Hand X-ray 3 views | CPT 73130 | $1,190.4 |
| MRI upper extremity joint without contrast | CPT 73221 | $4,861.8 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $3,306.03 |
| Knee X-ray 1-2 views | CPT 73560 | $1,076.4 |
| Ankle X-ray 3 views | CPT 73610 | $1,197.6 |
| MRI lower extremity joint without contrast | CPT 73721 | $5,358.57 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,638.32 |
| CT abdomen without contrast | CPT 74150 | $1,834.93 |
| CT abdomen with contrast | CPT 74160 | $2,272.93 |
| CT abdomen with and without contrast | CPT 74170 | $2,289.28 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,711.71 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,532.81 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,790.35 |
| Abdominal ultrasound complete | CPT 76700 | $875.7 |
| Abdominal ultrasound limited | CPT 76705 | $694.86 |
| Retroperitoneal ultrasound complete | CPT 76770 | $878.99 |
| Obstetric ultrasound first trimester | CPT 76801 | $986.4 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,258.4 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,530.4 |
| Transvaginal ultrasound | CPT 76830 | $1,382.4 |
| Pelvic ultrasound complete | CPT 76856 | $845.02 |
| Scrotal ultrasound | CPT 76870 | $630.2 |
| Diagnostic mammography unilateral | CPT 77065 | $775.2 |
| Screening mammography bilateral | CPT 77067 | $317.6 |
| EKG tracing only | CPT 93005 | $312 |
| Transthoracic echocardiogram complete | CPT 93306 | $2,716 |
| Transthoracic echocardiogram | CPT 93307 | $1,946.4 |
| Basic metabolic panel (BMP) | CPT 80048 | $221.6 |
| General health panel | CPT 80050 | $739.2 |
| Electrolyte panel | CPT 80051 | $161.6 |
| Comprehensive metabolic panel | CPT 80053 | $290.4 |
| Lipid panel | CPT 80061 | $292 |
| Renal function panel | CPT 80069 | $212 |
| Hepatic function panel | CPT 80076 | $166.4 |
| Urinalysis non-automated | CPT 81002 | $12.8 |
| Urinalysis automated | CPT 81003 | $9.6 |
| Glucose quantitative | CPT 82947 | $107.2 |
| Hemoglobin A1c | CPT 83036 | $40.63 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $259.2 |
| Complete blood count with automated differential | CPT 85025 | $180.8 |
| Complete blood count without differential | CPT 85027 | $86.4 |
| Urine culture bacterial | CPT 87086 | $352 |
| Urine culture identification | CPT 87088 | $165.6 |
| Tissue exam by pathologist level IV | CPT 88305 | $162.4 |
| Office visit, established patient, 5 min | CPT 99211 | $324.8 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,491.93 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,741.3 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,569.79 |
| Sigmoidoscopy with biopsy | CPT 45331 | $1,726.89 |
| Colonoscopy diagnostic | CPT 45378 | $6,202.08 |
| Colonoscopy with biopsy | CPT 45380 | $6,823.46 |
| Colonoscopy with polyp removal | CPT 45385 | $6,327.06 |
