| ED visit level 1 | CPT 99281 | $520.80 |
| ED visit level 2 | CPT 99282 | $614.60 |
| ED visit level 3 | CPT 99283 | $1,526.00 |
| ED visit level 4 | CPT 99284 | $2,130.80 |
| ED visit level 5 | CPT 99285 | $2,555.70 |
| Critical care, first hour | CPT 99291 | $3,439.10 |
| CT head without contrast | CPT 70450 | $1,694.00 |
| CT head with contrast | CPT 70460 | $1,337.00 |
| CT head with and without contrast | CPT 70470 | $2,045.40 |
| CT neck with contrast | CPT 70491 | $1,320.90 |
| MRI brain without contrast | CPT 70551 | $4,440.80 |
| MRI brain with contrast | CPT 70552 | $5,107.20 |
| MRI brain with and without contrast | CPT 70553 | $5,874.40 |
| Chest X-ray single view | CPT 71045 | $418.60 |
| Chest X-ray 2 views | CPT 71046 | $461.30 |
| Chest X-ray 3 views | CPT 71047 | $640.50 |
| CT chest without contrast | CPT 71250 | $3,802.40 |
| CT chest with contrast | CPT 71260 | $4,349.10 |
| CT chest with and without contrast | CPT 71270 | $3,502.10 |
| MRI chest without contrast | CPT 71550 | $5,365.50 |
| MRI chest with and without contrast | CPT 71552 | $5,036.50 |
| Lumbosacral spine X-ray | CPT 72100 | $935.90 |
| CT cervical spine without contrast | CPT 72125 | $2,381.40 |
| CT thoracic spine without contrast | CPT 72128 | $2,816.10 |
| CT lumbar spine without contrast | CPT 72131 | $3,019.80 |
| MRI cervical spine without contrast | CPT 72141 | $4,856.60 |
| MRI thoracic spine without contrast | CPT 72146 | $5,365.50 |
| MRI lumbar spine without contrast | CPT 72148 | $5,365.50 |
| MRI lumbar spine with and without contrast | CPT 72149 | $6,169.80 |
| MRI cervical spine with and without contrast | CPT 72156 | $5,663.00 |
| MRI lumbar spine with contrast | CPT 72158 | $6,256.60 |
| CT pelvis without contrast | CPT 72192 | $1,141.00 |
| CT pelvis with contrast | CPT 72193 | $1,325.10 |
| Shoulder X-ray | CPT 73030 | $916.65 |
| Humerus X-ray | CPT 73060 | $984.90 |
| Hand X-ray 3 views | CPT 73130 | $921.90 |
| MRI upper extremity joint without contrast | CPT 73221 | $6,957.30 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $7,973.70 |
| Knee X-ray 1-2 views | CPT 73560 | $1,090.95 |
| Ankle X-ray 3 views | CPT 73610 | $1,062.60 |
| MRI lower extremity joint without contrast | CPT 73721 | $6,957.30 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $6,134.10 |
| CT abdomen without contrast | CPT 74150 | $2,716.00 |
| CT abdomen with contrast | CPT 74160 | $4,988.90 |
| CT abdomen with and without contrast | CPT 74170 | $7,459.20 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,950.10 |
| CT abdomen and pelvis with contrast | CPT 74177 | $6,253.80 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $8,862.00 |
| MRI abdomen without contrast | CPT 74181 | $2,583.00 |
| MRI abdomen with and without contrast | CPT 74183 | $5,817.70 |
| Abdominal ultrasound complete | CPT 76700 | $1,915.20 |
| Abdominal ultrasound limited | CPT 76705 | $1,809.50 |
| Retroperitoneal ultrasound complete | CPT 76770 | $2,004.10 |
| Obstetric ultrasound first trimester | CPT 76801 | $1,649.90 |
| Obstetric ultrasound after first trimester | CPT 76805 | $928.90 |
| Transvaginal ultrasound | CPT 76830 | $1,570.10 |
| Pelvic ultrasound complete | CPT 76856 | $2,313.50 |
| Scrotal ultrasound | CPT 76870 | $2,142.70 |
| Diagnostic mammography unilateral | CPT 77065 | $686.00 |
| Diagnostic mammography bilateral | CPT 77066 | $908.60 |
| Screening mammography bilateral | CPT 77067 | $610.40 |
| EKG tracing only | CPT 93005 | $396.90 |
| EKG interpretation only | CPT 93010 | $23.80 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,213.80 |
| Transthoracic echocardiogram | CPT 93307 | $534.10 |
| Stress echocardiogram | CPT 93350 | $144.20 |
| Basic metabolic panel (BMP) | CPT 80048 | $129.50 |
| General health panel | CPT 80050 | $469.70 |
| Electrolyte panel | CPT 80051 | $189.70 |
| Comprehensive metabolic panel | CPT 80053 | $193.90 |
| Lipid panel | CPT 80061 | $109.20 |
| Renal function panel | CPT 80069 | $207.90 |
| Hepatic function panel | CPT 80076 | $129.50 |
| Urinalysis non-automated | CPT 81002 | $50.40 |
| Urinalysis automated | CPT 81003 | $22.40 |
| Glucose quantitative | CPT 82947 | $35.00 |
| Hemoglobin A1c | CPT 83036 | $49.70 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $246.40 |
| Complete blood count with automated differential | CPT 85025 | $93.80 |
| Complete blood count without differential | CPT 85027 | $62.30 |
| Urine culture bacterial | CPT 87086 | $94.50 |
| Tissue exam by pathologist level IV | CPT 88305 | $789.60 |
| Fetal non-stress test | CPT 59025 | $506.80 |
| Office visit, established patient, 5 min | CPT 99211 | $304.50 |
| Upper GI endoscopy diagnostic | CPT 43235 | $1,934.10 |
| Upper GI endoscopy with biopsy | CPT 43239 | $3,639.30 |
| Sigmoidoscopy diagnostic | CPT 45330 | $2,637.60 |
| Sigmoidoscopy with biopsy | CPT 45331 | $2,637.60 |
| Colonoscopy diagnostic | CPT 45378 | $4,338.60 |
| Colonoscopy with biopsy | CPT 45380 | $4,771.20 |
| Colonoscopy with polyp removal | CPT 45385 | $5,295.50 |
| PCI single major coronary artery | CPT 92920 | $8,098.30 |
| PCI with drug-eluting stent | CPT 92928 | $17,571 |
| PCI bypass graft | CPT 92937 | $12,300 |
| Coronary angiography with cath | CPT 93455 | $2,987.60 |
| Coronary angiography with bypass cath | CPT 93458 | $7,468.30 |
