| emergency |
| ED visit level 1 | CPT | 99281 | 0 | $223.19 | — | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $223.19 | — | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $398.97 | — | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $684.77 | — | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $684.77 | — | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $1,571.29 | — | — | — | — |
| imaging |
| CT head without contrast | CPT | 70450 | 0 | $1,193.29 | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $1,426.33 | — | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $1,869.54 | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $1,426.33 | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $3,776.75 | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $4,664.3 | — | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $6,554.45 | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $1,353.28 | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $1,619.32 | — | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $2,027.41 | — | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $3,776.75 | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $429.83 | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $2,747.23 | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $2,747.23 | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $3,731.63 | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $3,776.75 | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $3,776.75 | — | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $3,776.75 | — | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $4,664.3 | — | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $6,554.45 | — | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $6,554.45 | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $1,867.97 | — | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $2,400.06 | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $271.59 | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $271.59 | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $343.51 | — | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $6,699.15 | — | — | — | — |
| Hip X-ray 2 views | CPT | 73510 | 0 | $215.29 | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $271.59 | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $343.51 | — | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $3,706.67 | — | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $6,699.15 | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $1,735.37 | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $2,267.65 | — | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $2,400.06 | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $4,119.9 | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $3,352.45 | — | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $6,762.74 | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $754.6 | — | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $686.99 | — | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $754.6 | — | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $309.16 | — | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $633.71 | — | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $768.12 | — | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $754.6 | — | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $830.59 | — | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $459.99 | — | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $360.81 | — | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $1,713.39 | — | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,133.06 | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $295.06 | — | — | — | — |
| General health panel | CPT | 80050 | 0 | $76.91 | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $154.25 | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $568.48 | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $249.07 | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $256.64 | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $319.79 | — | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $99.71 | — | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $63.53 | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $63.53 | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $146.29 | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $136.32 | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $174.97 | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $152.88 | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $99.42 | — | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $142.51 | — | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $265.44 | — | — | — | — |
| maternity |
| C-section delivery only | CPT | 59514 | 0 | $6,194.19 | — | — | — | — |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 0 | $388.25 | — | — | — | — |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $1,685.36 | — | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $1,928.4 | — | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $1,544.01 | — | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $895.11 | — | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,248.3 | — | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $2,537.3 | — | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,269.4 | — | — | — | — |
| surgery |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $15,405 | — | — | — | — |