| ED visit level 1 | CPT 99281 | $630.36 |
| ED visit level 2 | CPT 99282 | $394.45 |
| ED visit level 3 | CPT 99283 | $575.92 |
| ED visit level 4 | CPT 99284 | $2,459.56 |
| ED visit level 5 | CPT 99285 | $3,199.4 |
| Critical care, first hour | CPT 99291 | $1,418.41 |
| CT head without contrast | CPT 70450 | $1,309.28 |
| CT head with contrast | CPT 70460 | $1,393.7 |
| CT head with and without contrast | CPT 70470 | $1,588.4 |
| CT neck with contrast | CPT 70491 | $1,357.13 |
| MRI brain without contrast | CPT 70551 | $1,604.9 |
| MRI brain with contrast | CPT 70552 | $1,720.95 |
| MRI brain with and without contrast | CPT 70553 | $1,833.98 |
| Chest X-ray single view | CPT 71045 | $487.62 |
| Chest X-ray 2 views | CPT 71046 | $685.62 |
| CT chest without contrast | CPT 71250 | $1,062.6 |
| CT chest with contrast | CPT 71260 | $1,281.5 |
| CT chest with and without contrast | CPT 71270 | $1,407.73 |
| MRI chest without contrast | CPT 71550 | $1,107.7 |
| MRI chest with contrast | CPT 71551 | $1,453 |
| Lumbosacral spine X-ray | CPT 72100 | $570.08 |
| CT cervical spine without contrast | CPT 72125 | $1,299.1 |
| CT thoracic spine without contrast | CPT 72128 | $1,115.4 |
| CT lumbar spine without contrast | CPT 72131 | $1,218.8 |
| MRI cervical spine without contrast | CPT 72141 | $1,456.4 |
| MRI thoracic spine without contrast | CPT 72146 | $1,289.2 |
| MRI lumbar spine without contrast | CPT 72148 | $1,470.15 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,617.28 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,920.05 |
| MRI lumbar spine with contrast | CPT 72158 | $1,915.65 |
| CT pelvis without contrast | CPT 72192 | $1,130.8 |
| CT pelvis with contrast | CPT 72193 | $1,273.8 |
| Shoulder X-ray | CPT 73030 | $765.03 |
| Humerus X-ray | CPT 73060 | $544.63 |
| Hand X-ray 3 views | CPT 73130 | $915.44 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,146.24 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,864.23 |
| Knee X-ray 1-2 views | CPT 73560 | $785.64 |
| Ankle X-ray 3 views | CPT 73610 | $920.02 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,366.51 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,818.3 |
| CT abdomen without contrast | CPT 74150 | $1,073.6 |
| CT abdomen with contrast | CPT 74160 | $1,228.43 |
| CT abdomen with and without contrast | CPT 74170 | $1,508.1 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,996.5 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,295.7 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $2,599.85 |
| MRI abdomen without contrast | CPT 74181 | $1,359.6 |
| MRI abdomen with and without contrast | CPT 74183 | $1,709.13 |
| Abdominal ultrasound complete | CPT 76700 | $970.63 |
| Abdominal ultrasound limited | CPT 76705 | $786.25 |
| Retroperitoneal ultrasound complete | CPT 76770 | $856.49 |
| Obstetric ultrasound first trimester | CPT 76801 | $633.71 |
| Obstetric ultrasound after first trimester | CPT 76805 | $1,223.64 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $1,256.72 |
| Transvaginal ultrasound | CPT 76830 | $797.09 |
| Pelvic ultrasound complete | CPT 76856 | $858.68 |
| Scrotal ultrasound | CPT 76870 | $754.2 |
| Diagnostic mammography unilateral | CPT 77065 | $458.85 |
| Diagnostic mammography bilateral | CPT 77066 | $571.14 |
| Screening mammography bilateral | CPT 77067 | $498.18 |
| EKG tracing only | CPT 93005 | $417.38 |
| Transthoracic echocardiogram complete | CPT 93306 | $3,244.37 |
| Stress echocardiogram | CPT 93350 | $2,862.11 |
| Basic metabolic panel (BMP) | CPT 80048 | $465.12 |
| General health panel | CPT 80050 | $868.35 |
| Electrolyte panel | CPT 80051 | $357.68 |
| Comprehensive metabolic panel | CPT 80053 | $557.6 |
| Lipid panel | CPT 80061 | $473.96 |
| Renal function panel | CPT 80069 | $528.36 |
| Hepatic function panel | CPT 80076 | $297.84 |
| Urinalysis non-automated | CPT 81002 | $108.12 |
| Urinalysis automated | CPT 81003 | $141.44 |
| Glucose quantitative | CPT 82947 | $208.08 |
| Hemoglobin A1c | CPT 83036 | $62.25 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $539.92 |
| Complete blood count with automated differential | CPT 85025 | $348.16 |
| Complete blood count without differential | CPT 85027 | $240.04 |
| Urine culture bacterial | CPT 87086 | $354.96 |
| Urine culture identification | CPT 87088 | $114.24 |
| Tissue exam by pathologist level IV | CPT 88305 | $609.96 |
| Fetal non-stress test | CPT 59025 | $477.95 |
| Office visit, established patient, 5 min | CPT 99211 | $650.98 |
| Upper GI endoscopy diagnostic | CPT 43235 | $2,520.08 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,698.52 |
| Sigmoidoscopy diagnostic | CPT 45330 | $2,290.92 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,000.56 |
| Colonoscopy diagnostic | CPT 45378 | $3,168.8 |
| Colonoscopy with biopsy | CPT 45380 | $3,361.24 |
| Colonoscopy with polyp removal | CPT 45385 | $3,486.36 |
