| ED visit level 1 | CPT 99281 | $201.00 |
| ED visit level 2 | CPT 99282 | $363.00 |
| ED visit level 3 | CPT 99283 | $639.00 |
| ED visit level 4 | CPT 99284 | $1,003.00 |
| ED visit level 5 | CPT 99285 | $1,440.00 |
| Critical care, first hour | CPT 99291 | $2,054.00 |
| CT head without contrast | CPT 70450 | $702.00 |
| CT head with contrast | CPT 70460 | $731.00 |
| CT head with and without contrast | CPT 70470 | $866.00 |
| CT neck with contrast | CPT 70491 | $731.00 |
| MRI brain without contrast | CPT 70551 | $1,590.00 |
| MRI brain with contrast | CPT 70552 | $1,817.00 |
| MRI brain with and without contrast | CPT 70553 | $3,534.00 |
| Chest X-ray single view | CPT 71045 | $223.00 |
| Chest X-ray 2 views | CPT 71046 | $223.00 |
| CT chest without contrast | CPT 71250 | $858.00 |
| CT chest with contrast | CPT 71260 | $1,014.00 |
| CT chest with and without contrast | CPT 71270 | $1,103.00 |
| MRI chest without contrast | CPT 71550 | $1,247.00 |
| MRI chest with contrast | CPT 71551 | $1,974.00 |
| MRI chest with and without contrast | CPT 71552 | $2,597.00 |
| Lumbosacral spine X-ray | CPT 72100 | $301.00 |
| CT cervical spine without contrast | CPT 72125 | $858.00 |
| CT thoracic spine without contrast | CPT 72128 | $858.00 |
| CT lumbar spine without contrast | CPT 72131 | $858.00 |
| MRI cervical spine without contrast | CPT 72141 | $1,590.00 |
| MRI thoracic spine without contrast | CPT 72146 | $1,768.00 |
| MRI lumbar spine without contrast | CPT 72148 | $1,768.00 |
| MRI lumbar spine with and without contrast | CPT 72149 | $1,520.00 |
| MRI cervical spine with and without contrast | CPT 72156 | $2,985.00 |
| MRI lumbar spine with contrast | CPT 72158 | $3,366.00 |
| CT pelvis without contrast | CPT 72192 | $817.00 |
| CT pelvis with contrast | CPT 72193 | $855.00 |
| Shoulder X-ray | CPT 73030 | $256.00 |
| Humerus X-ray | CPT 73060 | $223.00 |
| Hand X-ray 3 views | CPT 73130 | $223.00 |
| MRI upper extremity joint without contrast | CPT 73221 | $1,590.00 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $2,603.00 |
| Knee X-ray 1-2 views | CPT 73560 | $223.00 |
| Ankle X-ray 3 views | CPT 73610 | $223.00 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,416.00 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $2,603.00 |
| CT abdomen without contrast | CPT 74150 | $792.00 |
| CT abdomen with contrast | CPT 74160 | $941.00 |
| CT abdomen with and without contrast | CPT 74170 | $1,080.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,017.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,040.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,337.00 |
| MRI abdomen without contrast | CPT 74181 | $1,247.00 |
| MRI abdomen with and without contrast | CPT 74183 | $3,861.00 |
| Abdominal ultrasound complete | CPT 76700 | $330.00 |
| Abdominal ultrasound limited | CPT 76705 | $300.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $319.00 |
| Obstetric ultrasound after first trimester | CPT 76805 | $373.00 |
| Transvaginal ultrasound | CPT 76830 | $300.00 |
| Pelvic ultrasound complete | CPT 76856 | $300.00 |
| Scrotal ultrasound | CPT 76870 | $301.00 |
| EKG tracing only | CPT 93005 | $153.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,332.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $89.00 |
| General health panel | CPT 80050 | $237.00 |
| Electrolyte panel | CPT 80051 | $27.00 |
| Comprehensive metabolic panel | CPT 80053 | $156.00 |
| Lipid panel | CPT 80061 | $83.00 |
| Renal function panel | CPT 80069 | $216.00 |
| Hepatic function panel | CPT 80076 | $97.00 |
| Urinalysis non-automated | CPT 81002 | $41.00 |
| Urinalysis automated | CPT 81003 | $27.00 |
| Glucose quantitative | CPT 82947 | $50.00 |
| Hemoglobin A1c | CPT 83036 | $58.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $104.00 |
| Complete blood count with automated differential | CPT 85025 | $48.00 |
| Complete blood count without differential | CPT 85027 | $40.00 |
| Urine culture identification | CPT 87088 | $32.00 |
| Vaginal delivery only | CPT 59409 | $7,234.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $95.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $131.00 |
| Office visit, new patient, 45-59 min | CPT 99204 | $180.00 |
| Office visit, new patient, 60-74 min | CPT 99205 | $216.00 |
| Office visit, established patient, 5 min | CPT 99211 | $36.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $68.00 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $90.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $123.00 |
| Office visit, established patient, 40-54 min | CPT 99215 | $135.00 |
