| ED visit level 1 | CPT 99281 | $387 |
| ED visit level 2 | CPT 99282 | $713 |
| ED visit level 3 | CPT 99283 | $1,243.5 |
| ED visit level 4 | CPT 99284 | $1,931 |
| ED visit level 5 | CPT 99285 | $2,805 |
| Critical care, first hour | CPT 99291 | $3,084.5 |
| CT head without contrast | CPT 70450 | $1,928 |
| CT head with contrast | CPT 70460 | $2,656.5 |
| CT head with and without contrast | CPT 70470 | $2,670 |
| CT neck with contrast | CPT 70491 | $2,422 |
| MRI brain without contrast | CPT 70551 | $941.5 |
| MRI brain with and without contrast | CPT 70553 | $1,536 |
| Chest X-ray single view | CPT 71045 | $320.5 |
| Chest X-ray 2 views | CPT 71046 | $460.5 |
| Chest X-ray 3 views | CPT 71047 | $532.5 |
| CT chest without contrast | CPT 71250 | $1,802.5 |
| CT chest with contrast | CPT 71260 | $1,139 |
| CT chest with and without contrast | CPT 71270 | $2,799 |
| MRI chest without contrast | CPT 71550 | $941.5 |
| MRI chest with and without contrast | CPT 71552 | $1,464 |
| Lumbosacral spine X-ray | CPT 72100 | $479.5 |
| CT cervical spine without contrast | CPT 72125 | $2,145.5 |
| CT thoracic spine without contrast | CPT 72128 | $2,834.5 |
| CT lumbar spine without contrast | CPT 72131 | $2,772.5 |
| MRI cervical spine without contrast | CPT 72141 | $941.5 |
| MRI thoracic spine without contrast | CPT 72146 | $941.5 |
| MRI lumbar spine without contrast | CPT 72148 | $941.5 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,464 |
| MRI lumbar spine with contrast | CPT 72158 | $1,464 |
| CT pelvis without contrast | CPT 72192 | $2,034 |
| CT pelvis with contrast | CPT 72193 | $2,984 |
| Shoulder X-ray | CPT 73030 | $412.5 |
| Humerus X-ray | CPT 73060 | $417.5 |
| Hand X-ray 3 views | CPT 73130 | $322 |
| MRI upper extremity joint without contrast | CPT 73221 | $941.5 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,464 |
| Knee X-ray 1-2 views | CPT 73560 | $400 |
| Ankle X-ray 3 views | CPT 73610 | $435.5 |
| MRI lower extremity joint without contrast | CPT 73721 | $941.5 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $1,464 |
| CT abdomen without contrast | CPT 74150 | $1,972 |
| CT abdomen with contrast | CPT 74160 | $2,425.5 |
| CT abdomen with and without contrast | CPT 74170 | $2,541 |
| CT abdomen and pelvis without contrast | CPT 74176 | $3,633.5 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,683 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,727.5 |
| MRI abdomen without contrast | CPT 74181 | $941.5 |
| MRI abdomen with and without contrast | CPT 74183 | $1,464 |
| Abdominal ultrasound complete | CPT 76700 | $814 |
| Abdominal ultrasound limited | CPT 76705 | $814 |
| Retroperitoneal ultrasound complete | CPT 76770 | $814 |
| Obstetric ultrasound first trimester | CPT 76801 | $814 |
| Obstetric ultrasound after first trimester | CPT 76805 | $528 |
| Obstetric ultrasound with fetal anatomy | CPT 76811 | $874 |
| Transvaginal ultrasound | CPT 76830 | $814 |
| Pelvic ultrasound complete | CPT 76856 | $814 |
| Scrotal ultrasound | CPT 76870 | $814 |
| Diagnostic mammography unilateral | CPT 77065 | $456.5 |
| Diagnostic mammography bilateral | CPT 77066 | $577.5 |
| Screening mammography bilateral | CPT 77067 | $467 |
| EKG complete | CPT 93000 | $46 |
| EKG tracing only | CPT 93005 | $261 |
| Basic metabolic panel (BMP) | CPT 80048 | $84 |
| Electrolyte panel | CPT 80051 | $70.5 |
| Comprehensive metabolic panel | CPT 80053 | $206 |
| Lipid panel | CPT 80061 | $42 |
| Renal function panel | CPT 80069 | $95 |
| Hepatic function panel | CPT 80076 | $23.5 |
| Urinalysis non-automated | CPT 81002 | $36.5 |
| Urinalysis automated | CPT 81003 | $16.5 |
| Glucose quantitative | CPT 82947 | $68.5 |
| Hemoglobin A1c | CPT 83036 | $97 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $50 |
| Complete blood count with automated differential | CPT 85025 | $73 |
| Complete blood count without differential | CPT 85027 | $9.5 |
| Urine culture identification | CPT 87088 | $88.5 |
| Tissue exam by pathologist level IV | CPT 88305 | $131.5 |
| Fetal non-stress test | CPT 59025 | $869.5 |
| Routine obstetric care including vaginal delivery | CPT 59400 | $8,375 |
| Vaginal delivery only | CPT 59409 | $11,637 |
| C-section delivery only | CPT 59514 | $1,830 |
| Office visit, new patient, 15-29 min | CPT 99202 | $248 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $337 |
| Office visit, new patient, 45-59 min | CPT 99204 | $432 |
| Office visit, new patient, 60-74 min | CPT 99205 | $547 |
| Office visit, established patient, 5 min | CPT 99211 | $137.5 |
| Office visit, established patient, 10-19 min | CPT 99212 | $196.5 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $315.5 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $448 |
| Office visit, established patient, 40-54 min | CPT 99215 | $626 |
| Upper GI endoscopy diagnostic | CPT 43235 | $443 |
| Upper GI endoscopy with biopsy | CPT 43239 | $2,218 |
| Colonoscopy diagnostic | CPT 45378 | $1,250.5 |
| Colonoscopy with biopsy | CPT 45380 | $1,456.5 |
| Colonoscopy with polyp removal | CPT 45385 | $708 |
| Shoulder arthroscopy with decompression | CPT 29826 | $446.5 |
| Knee arthroscopy with meniscectomy | CPT 29881 | $1,429.5 |
