| ED visit level 1 | CPT 99281 | $88.24 |
| ED visit level 2 | CPT 99282 | $160.68 |
| ED visit level 3 | CPT 99283 | $285.65 |
| ED visit level 4 | CPT 99284 | $436.63 |
| ED visit level 5 | CPT 99285 | $623.18 |
| Critical care, first hour | CPT 99291 | $864.37 |
| CT head without contrast | CPT 70450 | $109.4 |
| CT head with contrast | CPT 70460 | $183.54 |
| CT head with and without contrast | CPT 70470 | $183.54 |
| CT neck with contrast | CPT 70491 | $183.54 |
| MRI brain without contrast | CPT 70551 | $249.68 |
| MRI brain with contrast | CPT 70552 | $365.07 |
| MRI brain with and without contrast | CPT 70553 | $365.07 |
| Chest X-ray single view | CPT 71045 | $90.64 |
| Chest X-ray 2 views | CPT 71046 | $90.64 |
| Chest X-ray 3 views | CPT 71047 | $90.64 |
| CT chest without contrast | CPT 71250 | $109.4 |
| CT chest with contrast | CPT 71260 | $183.54 |
| CT chest with and without contrast | CPT 71270 | $183.54 |
| MRI chest without contrast | CPT 71550 | $249.68 |
| Lumbosacral spine X-ray | CPT 72100 | $109.4 |
| CT cervical spine without contrast | CPT 72125 | $109.4 |
| CT thoracic spine without contrast | CPT 72128 | $109.4 |
| CT lumbar spine without contrast | CPT 72131 | $109.4 |
| MRI cervical spine without contrast | CPT 72141 | $249.68 |
| MRI thoracic spine without contrast | CPT 72146 | $249.68 |
| MRI lumbar spine without contrast | CPT 72148 | $249.68 |
| MRI lumbar spine with and without contrast | CPT 72149 | $365.07 |
| MRI cervical spine with and without contrast | CPT 72156 | $365.07 |
| MRI lumbar spine with contrast | CPT 72158 | $365.07 |
| CT pelvis without contrast | CPT 72192 | $109.4 |
| CT pelvis with contrast | CPT 72193 | $183.54 |
| Shoulder X-ray | CPT 73030 | $90.64 |
| Humerus X-ray | CPT 73060 | $90.64 |
| Hand X-ray 3 views | CPT 73130 | $90.64 |
| MRI upper extremity joint without contrast | CPT 73221 | $249.68 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $365.07 |
| Knee X-ray 1-2 views | CPT 73560 | $90.64 |
| Ankle X-ray 3 views | CPT 73610 | $90.64 |
| MRI lower extremity joint without contrast | CPT 73721 | $249.68 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $365.07 |
| CT abdomen without contrast | CPT 74150 | $109.4 |
| CT abdomen with contrast | CPT 74160 | $183.54 |
| CT abdomen with and without contrast | CPT 74170 | $183.54 |
| CT abdomen and pelvis without contrast | CPT 74176 | $249.68 |
| CT abdomen and pelvis with contrast | CPT 74177 | $365.07 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $365.07 |
| MRI abdomen without contrast | CPT 74181 | $249.68 |
| MRI abdomen with and without contrast | CPT 74183 | $365.07 |
| Abdominal ultrasound complete | CPT 76700 | $109.4 |
| Abdominal ultrasound limited | CPT 76705 | $109.4 |
| Retroperitoneal ultrasound complete | CPT 76770 | $109.4 |
| Obstetric ultrasound first trimester | CPT 76801 | $108.88 |
| Obstetric ultrasound after first trimester | CPT 76805 | $108.88 |
| Transvaginal ultrasound | CPT 76830 | $108.88 |
| Pelvic ultrasound complete | CPT 76856 | $109.4 |
| Scrotal ultrasound | CPT 76870 | $109.4 |
| EKG tracing only | CPT 93005 | $61.15 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG 871 | $14,365 |
| Basic metabolic panel (BMP) | CPT 80048 | $9.05 |
| Electrolyte panel | CPT 80051 | $7.5 |
| Comprehensive metabolic panel | CPT 80053 | $11.3 |
| Lipid panel | CPT 80061 | $14.33 |
| Renal function panel | CPT 80069 | $9.29 |
| Hepatic function panel | CPT 80076 | $8.74 |
| Urinalysis automated | CPT 81003 | $2.41 |
| Glucose quantitative | CPT 82947 | $4.21 |
| Hemoglobin A1c | CPT 83036 | $10.39 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $17.98 |
| Complete blood count with automated differential | CPT 85025 | $8.31 |
| Urine culture bacterial | CPT 87086 | $8.63 |
| Tissue exam by pathologist level IV | CPT 88305 | $54.27 |
| Office visit, new patient, 15-29 min | CPT 99202 | $130.81 |
| Office visit, new patient, 30-44 minutes | CPT 99203 | $130.81 |
| Office visit, new patient, 45-59 min | CPT 99204 | $137.35 |
| Office visit, new patient, 60-74 min | CPT 99205 | $138.66 |
| Office visit, established patient, 5 min | CPT 99211 | $130.81 |
| Office visit, established patient, 10-19 min | CPT 99212 | $130.81 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $130.81 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $137.35 |
| Office visit, established patient, 40-54 min | CPT 99215 | $137.35 |
| Spinal fusion (non-cervical) w MCC | MS-DRG 459 | $153,070 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG 460 | $86,908 |
| Major joint replacement w MCC | MS-DRG 469 | $22,431 |
| Major joint replacement w/o MCC | MS-DRG 470 | $14,264 |
