| emergency |
| ED visit level 3 | CPT | 99283 | 14 | — | — | $152.67 | $776.32 | 1.9× | $1,144.54 |
| ED visit level 4 | CPT | 99284 | 14 | — | — | $240.5 | $1,222.95 | 1.8× | $1,803.02 |
| ED visit level 5 | CPT | 99285 | 14 | — | — | $300.65 | $1,528.83 | 1.5× | $2,253.99 |
| imaging |
| CT head without contrast | CPT | 70450 | 14 | — | — | $167.76 | $870.55 | 4.2× | $2,328.75 |
| CT head with contrast | CPT | 70460 | 14 | — | — | $65.27 | $331.88 | 1.4× | $815.3 |
| MRI brain without contrast | CPT | 70551 | 14 | — | — | $248.33 | $1,262.75 | 3.1× | $3,333.6 |
| MRI brain with contrast | CPT | 70552 | 14 | — | — | $399.56 | $2,031.76 | 4.2× | $5,663.15 |
| MRI brain with and without contrast | CPT | 70553 | 14 | — | — | $622.21 | $3,163.98 | 5.4× | $8,598.34 |
| Chest X-ray single view | CPT | 71045 | 14 | — | — | $19.25 | $97.9 | 1.0× | $152.5 |
| Chest X-ray 2 views | CPT | 71046 | 14 | — | — | $31.81 | $161.75 | 1.6× | $252.41 |
| CT chest without contrast | CPT | 71250 | 14 | — | — | $241.23 | $1,226.66 | 5.7× | $3,273.42 |
| CT chest with contrast | CPT | 71260 | 14 | — | — | $285.44 | $1,451.46 | 5.2× | $3,829.41 |
| CT chest with and without contrast | CPT | 71270 | 14 | — | — | $310.83 | $1,632.48 | 5.6× | $4,497.83 |
| Lumbosacral spine X-ray | CPT | 72100 | 14 | — | — | $31.81 | $161.75 | 1.6× | $240.44 |
| CT cervical spine without contrast | CPT | 72125 | 14 | — | — | $186.52 | $948.48 | 4.7× | $2,557.43 |
| CT thoracic spine without contrast | CPT | 72128 | 14 | — | — | $186.52 | $948.48 | 4.8× | $2,540.58 |
| CT lumbar spine without contrast | CPT | 72131 | 14 | — | — | $197.96 | $1,006.66 | 5.0× | $2,715.89 |
| MRI cervical spine without contrast | CPT | 72141 | 14 | — | — | $320.32 | $1,628.81 | 4.1× | $4,378.39 |
| MRI thoracic spine without contrast | CPT | 72146 | 14 | — | — | $320.32 | $1,628.81 | 4.4× | $4,236.44 |
| MRI lumbar spine without contrast | CPT | 72148 | 14 | — | — | $320.32 | $1,628.81 | 4.3× | $4,422.09 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 14 | — | — | $463.03 | $2,439.92 | 5.4× | $6,712.35 |
| MRI cervical spine with and without contrast | CPT | 72156 | 14 | — | — | $622.21 | $3,163.98 | 5.9× | $8,469.01 |
| MRI lumbar spine with contrast | CPT | 72158 | 14 | — | — | $622.21 | $3,163.98 | 5.8× | $8,404.01 |
| CT pelvis without contrast | CPT | 72192 | 14 | — | — | $173.27 | $977.51 | 4.9× | $2,020.53 |
| CT pelvis with contrast | CPT | 72193 | 14 | — | — | $173.27 | $993.37 | 3.5× | $1,812.34 |
| Shoulder X-ray | CPT | 73030 | 14 | — | — | $31.81 | $161.75 | 1.7× | $239.46 |
| Humerus X-ray | CPT | 73060 | 14 | — | — | $31.81 | $161.75 | 1.8× | $238.47 |
| Hand X-ray 3 views | CPT | 73130 | 14 | — | — | $25.39 | $143.28 | 1.5× | $196.27 |
| MRI upper extremity joint without contrast | CPT | 73221 | 14 | — | — | $253.63 | $1,368.2 | 3.3× | $3,724.18 |
| Knee X-ray 1-2 views | CPT | 73560 | 14 | — | — | $25.39 | $132.09 | 1.4× | $197.36 |
| Ankle X-ray 3 views | CPT | 73610 | 14 | — | — | $25.39 | $140.45 | 1.5× | $200.75 |
| MRI lower extremity joint without contrast | CPT | 73721 | 14 | — | — | $253.63 | $1,311.47 | 2.8× | $3,639.34 |
| CT abdomen without contrast | CPT | 74150 | 14 | — | — | $32.51 | $171.69 | 0.91× | $564.38 |
| CT abdomen with and without contrast | CPT | 74170 | 14 | — | — | $73.06 | $371.53 | 1.1× | $1,033.91 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 14 | — | — | $131.56 | $668.97 | 1.8× | $1,795.73 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 14 | — | — | $203.68 | $1,035.74 | 1.9× | $2,744.28 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 14 | — | — | $101.74 | $534.34 | 0.93× | $1,472.21 |
| MRI abdomen without contrast | CPT | 74181 | 14 | — | — | $320.32 | $1,628.81 | 4.2× | $4,336.88 |
| MRI abdomen with and without contrast | CPT | 74183 | 14 | — | — | $476.15 | $2,421.22 | 4.3× | $6,446.75 |
| Abdominal ultrasound complete | CPT | 76700 | 14 | — | — | $59.99 | $312.43 | 2.1× | $483.22 |
| Abdominal ultrasound limited | CPT | 76705 | 14 | — | — | $44.36 | $225.59 | 1.5× | $332.6 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 14 | — | — | $70.03 | $356.13 | 2.5× | $566.63 |
| EKG tracing only | CPT | 93005 | 14 | — | — | $7.02 | $37.29 | 0.32× | $53.11 |
| Transthoracic echocardiogram complete | CPT | 93306 | 14 | — | — | $175.5 | $892.44 | 1.5× | $1,315.74 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 14 | — | — | $24.27 | $123.44 | 3.8× | $181.98 |
| Comprehensive metabolic panel | CPT | 80053 | 14 | — | — | $12.14 | $62.45 | 1.4× | $92.16 |
| Lipid panel | CPT | 80061 | 14 | — | — | $8.65 | $48.43 | 1.3× | $74.18 |
| Renal function panel | CPT | 80069 | 14 | — | — | $6.14 | $31.21 | 1.1× | $46.02 |
| Hepatic function panel | CPT | 80076 | 14 | — | — | $10.46 | $53.21 | 2.0× | $83.91 |
| Urinalysis automated | CPT | 81003 | 14 | — | — | $3.93 | $20.26 | 1.5× | $29.87 |
| Glucose quantitative | CPT | 82947 | 14 | — | — | $1.95 | $10.57 | 0.60× | $15.8 |
| Hemoglobin A1c | CPT | 83036 | 14 | — | — | $9.35 | $50.66 | 1.9× | $76.18 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 14 | — | — | $14.65 | $75.31 | 1.6× | $113.64 |
| Complete blood count with automated differential | CPT | 85025 | 14 | — | — | $7.53 | $38.31 | 1.4× | $58.17 |
| Complete blood count without differential | CPT | 85027 | 14 | — | — | $7.53 | $40.08 | 1.9× | $59.7 |
| Urine culture bacterial | CPT | 87086 | 14 | — | — | $5.58 | $29.43 | 1.3× | $46.97 |
| Tissue exam by pathologist level IV | CPT | 88305 | 14 | — | — | $8.53 | $43.4 | 0.42× | $63.98 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 14 | — | — | $14.34 | $72.91 | 0.85× | $107.5 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 14 | — | — | $19.81 | $101.45 | 0.83× | $148.52 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 14 | — | — | $25.95 | $129.44 | 0.74× | $194.55 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 14 | — | — | $43.95 | $223.47 | 1.0× | $329.46 |
| Office visit, established patient, 5 min | CPT | 99211 | 14 | — | — | $14.34 | $72.91 | 1.1× | $107.5 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 14 | — | — | $14.34 | $72.91 | 0.91× | $107.5 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 14 | — | — | $14.79 | $78.87 | 0.69× | $110.87 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 14 | — | — | $19.11 | $98.95 | 0.65× | $143.28 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 14 | — | — | $28.18 | $143.3 | 0.76× | $211.27 |