| ED visit level 4 | CPT 99284 | $623.75 |
| ED visit level 5 | CPT 99285 | $1,133.69 |
| CT head without contrast | CPT 70450 | $1,030.00 |
| CT head with and without contrast | CPT 70470 | $2,179.25 |
| CT neck with contrast | CPT 70491 | $1,922.00 |
| MRI brain without contrast | CPT 70551 | $1,130.25 |
| MRI brain with and without contrast | CPT 70553 | $1,529.25 |
| Chest X-ray single view | CPT 71045 | $320.73 |
| Chest X-ray 2 views | CPT 71046 | $420.73 |
| CT chest without contrast | CPT 71250 | $1,068.00 |
| CT chest with contrast | CPT 71260 | $1,993.25 |
| Lumbosacral spine X-ray | CPT 72100 | $405.98 |
| CT thoracic spine without contrast | CPT 72128 | $1,525.75 |
| CT lumbar spine without contrast | CPT 72131 | $1,525.75 |
| MRI thoracic spine without contrast | CPT 72146 | $2,276.25 |
| MRI lumbar spine without contrast | CPT 72148 | $2,276.25 |
| MRI cervical spine with and without contrast | CPT 72156 | $1,529.25 |
| MRI lumbar spine with contrast | CPT 72158 | $3,079.25 |
| CT pelvis without contrast | CPT 72192 | $1,525.75 |
| CT pelvis with contrast | CPT 72193 | $1,993.25 |
| Shoulder X-ray | CPT 73030 | $405.98 |
| Humerus X-ray | CPT 73060 | $405.98 |
| Hand X-ray 3 views | CPT 73130 | $449.34 |
| Knee X-ray 1-2 views | CPT 73560 | $355.59 |
| MRI lower extremity joint without contrast | CPT 73721 | $1,593.50 |
| CT abdomen and pelvis without contrast | CPT 74176 | $2,136.00 |
| CT abdomen and pelvis with contrast | CPT 74177 | $2,790.75 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $4,521.00 |
| MRI abdomen without contrast | CPT 74181 | $2,276.25 |
| MRI abdomen with and without contrast | CPT 74183 | $2,566.25 |
| Abdominal ultrasound complete | CPT 76700 | $431.59 |
| Abdominal ultrasound limited | CPT 76705 | $285.48 |
| EKG tracing only | CPT 93005 | $351.22 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,830.07 |
| Basic metabolic panel (BMP) | CPT 80048 | $81.77 |
| Electrolyte panel | CPT 80051 | $294.47 |
| Comprehensive metabolic panel | CPT 80053 | $119.77 |
| Lipid panel | CPT 80061 | $263.49 |
| Renal function panel | CPT 80069 | $119.77 |
| Hepatic function panel | CPT 80076 | $161.07 |
| Urinalysis automated | CPT 81003 | $62.78 |
| Glucose quantitative | CPT 82947 | $39.24 |
| Hemoglobin A1c | CPT 83036 | $68.15 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $183.79 |
| Complete blood count with automated differential | CPT 85025 | $109.86 |
| Complete blood count without differential | CPT 85027 | $201.13 |
| Urine culture bacterial | CPT 87086 | $130.51 |
| Urine culture identification | CPT 87088 | $157.75 |
| Tissue exam by pathologist level IV | CPT 88305 | $464.21 |
| Office visit, established patient, 5 min | CPT 99211 | $66.45 |
| Upper GI endoscopy diagnostic | CPT 43235 | $944.04 |
| Upper GI endoscopy with biopsy | CPT 43239 | $1,038.41 |
| Sigmoidoscopy diagnostic | CPT 45330 | $1,435.31 |
| Colonoscopy with biopsy | CPT 45380 | $1,778.70 |
| Colonoscopy with polyp removal | CPT 45385 | $1,876.02 |
| Coronary angiography with bypass cath | CPT 93458 | $14,234 |
