| ED visit level 1 | CPT 99281 | $165.00 |
| ED visit level 2 | CPT 99282 | $289.00 |
| ED visit level 3 | CPT 99283 | $454.00 |
| ED visit level 4 | CPT 99284 | $659.00 |
| ED visit level 5 | CPT 99285 | $906.00 |
| Critical care, first hour | CPT 99291 | $1,428.00 |
| CT head without contrast | CPT 70450 | $742.00 |
| CT head with contrast | CPT 70460 | $1,010.00 |
| CT head with and without contrast | CPT 70470 | $1,154.00 |
| CT neck with contrast | CPT 70491 | $1,050.00 |
| Chest X-ray single view | CPT 71045 | $186.00 |
| Chest X-ray 2 views | CPT 71046 | $186.00 |
| CT chest without contrast | CPT 71250 | $742.00 |
| CT chest with contrast | CPT 71260 | $1,010.00 |
| CT chest with and without contrast | CPT 71270 | $1,154.00 |
| Lumbosacral spine X-ray | CPT 72100 | $223.00 |
| CT cervical spine without contrast | CPT 72125 | $742.00 |
| CT thoracic spine without contrast | CPT 72128 | $680.00 |
| CT lumbar spine without contrast | CPT 72131 | $722.00 |
| CT pelvis without contrast | CPT 72192 | $637.00 |
| CT pelvis with contrast | CPT 72193 | $1,010.00 |
| Shoulder X-ray | CPT 73030 | $160.00 |
| Humerus X-ray | CPT 73060 | $160.00 |
| Hand X-ray 3 views | CPT 73130 | $223.00 |
| Knee X-ray 1-2 views | CPT 73560 | $160.00 |
| Ankle X-ray 3 views | CPT 73610 | $148.00 |
| CT abdomen without contrast | CPT 74150 | $662.00 |
| CT abdomen with contrast | CPT 74160 | $1,010.00 |
| CT abdomen with and without contrast | CPT 74170 | $1,236.00 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,273.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,545.00 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $1,730.00 |
| Abdominal ultrasound complete | CPT 76700 | $492.00 |
| Abdominal ultrasound limited | CPT 76705 | $293.00 |
| Retroperitoneal ultrasound complete | CPT 76770 | $492.00 |
| Obstetric ultrasound first trimester | CPT 76801 | $318.00 |
| Obstetric ultrasound after first trimester | CPT 76805 | $309.00 |
| Pelvic ultrasound complete | CPT 76856 | $293.00 |
| Scrotal ultrasound | CPT 76870 | $293.00 |
| EKG tracing only | CPT 93005 | $140.00 |
| Transthoracic echocardiogram complete | CPT 93306 | $948.00 |
| Stress echocardiogram | CPT 93350 | $2,061.00 |
| Basic metabolic panel (BMP) | CPT 80048 | $65.00 |
| General health panel | CPT 80050 | $245.00 |
| Electrolyte panel | CPT 80051 | $57.00 |
| Comprehensive metabolic panel | CPT 80053 | $99.00 |
| Lipid panel | CPT 80061 | $85.00 |
| Renal function panel | CPT 80069 | $76.00 |
| Hepatic function panel | CPT 80076 | $67.00 |
| Urinalysis non-automated | CPT 81002 | $30.00 |
| Urinalysis automated | CPT 81003 | $38.00 |
| Glucose quantitative | CPT 82947 | $51.00 |
| Hemoglobin A1c | CPT 83036 | $200.00 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $85.00 |
| Complete blood count with automated differential | CPT 85025 | $57.00 |
| Complete blood count without differential | CPT 85027 | $51.00 |
| Urine culture bacterial | CPT 87086 | $61.00 |
| Vaginal delivery only | CPT 59409 | $1,978.00 |
| Office visit, new patient, 15-29 min | CPT 99202 | $104.00 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $144.00 |
| Office visit, new patient, 45-59 min | CPT 99204 | $196.00 |
| Office visit, new patient, 60-74 min | CPT 99205 | $244.00 |
| Office visit, established patient, 5 min | CPT 99211 | $48.00 |
| Office visit, established patient, 10-19 min | CPT 99212 | $60.00 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $80.00 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $120.00 |
| Office visit, established patient, 40-54 min | CPT 99215 | $180.00 |
