| emergency |
| ED visit level 1 | CPT | 99281 | 15 | — | — | $60.42 | $181.24 | 1.3× | $515 |
| ED visit level 2 | CPT | 99282 | 15 | — | — | $148.68 | $289.98 | 1.2× | $763.85 |
| ED visit level 3 | CPT | 99283 | 15 | — | — | $228.53 | $445.73 | 1.1× | $1,174.09 |
| ED visit level 4 | CPT | 99284 | 15 | — | — | $357.65 | $697.55 | 1.0× | $1,837.41 |
| ED visit level 5 | CPT | 99285 | 15 | — | — | $532.72 | $1,072.35 | 1.0× | $2,736.86 |
| Critical care, first hour | CPT | 99291 | 15 | — | — | $459.64 | $925.25 | 0.86× | $2,423.29 |
| imaging |
| CT head without contrast | CPT | 70450 | 15 | — | — | $315.48 | $635.05 | 3.1× | $1,620.77 |
| CT head with contrast | CPT | 70460 | 15 | — | — | $419.65 | $774.18 | 3.3× | $2,356.92 |
| CT head with and without contrast | CPT | 70470 | 15 | — | — | $380.78 | $889.35 | 3.3× | $2,585.09 |
| CT neck with contrast | CPT | 70491 | 15 | — | — | $358.87 | $689.02 | 2.5× | $1,843.7 |
| MRI brain without contrast | CPT | 70551 | 15 | — | — | $435.24 | $1,093.38 | 2.7× | $2,888.91 |
| MRI brain with contrast | CPT | 70552 | 15 | — | — | $359.57 | $1,393.94 | 2.9× | $3,686.87 |
| MRI brain with and without contrast | CPT | 70553 | 15 | — | — | $654.58 | $1,860.42 | 3.2× | $4,900.53 |
| Chest X-ray single view | CPT | 71045 | 15 | — | — | $101.89 | $202.53 | 2.1× | $523.46 |
| Chest X-ray 2 views | CPT | 71046 | 15 | — | — | $101.89 | $198.72 | 2.0× | $523.46 |
| Chest X-ray 3 views | CPT | 71047 | 15 | — | — | $117.19 | $235.9 | 2.5× | $668.96 |
| CT chest without contrast | CPT | 71250 | 15 | — | — | $279.38 | $713.52 | 3.3× | $2,032.37 |
| CT chest with contrast | CPT | 71260 | 15 | — | — | $305.65 | $884.15 | 3.1× | $2,569.97 |
| CT chest with and without contrast | CPT | 71270 | 15 | — | — | $609.18 | $1,188.14 | 4.1× | $3,129.68 |
| MRI chest without contrast | CPT | 71550 | 15 | — | — | $558.95 | $1,090.17 | 2.5× | $3,190.68 |
| MRI chest with and without contrast | CPT | 71552 | 15 | — | — | $93.81 | $1,632.11 | 2.7× | $5,271.23 |
| Lumbosacral spine X-ray | CPT | 72100 | 15 | — | — | $84.2 | $150.56 | 1.5× | $432.58 |
| CT cervical spine without contrast | CPT | 72125 | 15 | — | — | $328.59 | $640.89 | 3.2× | $1,688.16 |
| CT thoracic spine without contrast | CPT | 72128 | 15 | — | — | $315.77 | $569.71 | 2.9× | $1,622.29 |
| CT lumbar spine without contrast | CPT | 72131 | 15 | — | — | $343.12 | $669.21 | 3.3× | $1,762.77 |
| MRI cervical spine without contrast | CPT | 72141 | 15 | — | — | $241.88 | $870.34 | 2.2× | $2,422.52 |
| MRI thoracic spine without contrast | CPT | 72146 | 15 | — | — | $450.87 | $884.78 | 2.4× | $2,433.77 |
| MRI lumbar spine without contrast | CPT | 72148 | 15 | — | — | $400.76 | $933.68 | 2.5× | $2,459.4 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 15 | — | — | $590.2 | $1,188.06 | 2.6× | $3,032.17 |
| MRI cervical spine with and without contrast | CPT | 72156 | 15 | — | — | $736.49 | $1,539.73 | 2.8× | $4,100.95 |
| MRI lumbar spine with contrast | CPT | 72158 | 15 | — | — | $813.67 | $1,585.24 | 2.9× | $4,180.28 |
| CT pelvis without contrast | CPT | 72192 | 15 | — | — | $260.31 | $556.6 | 2.8× | $1,644.31 |
| CT pelvis with contrast | CPT | 72193 | 15 | — | — | $414.43 | $826.41 | 2.9× | $2,297.5 |
| Shoulder X-ray | CPT | 73030 | 15 | — | — | $25.04 | $118.39 | 1.3× | $344.12 |
| Humerus X-ray | CPT | 73060 | 15 | — | — | $64.29 | $129.42 | 1.4× | $330.3 |
| Hand X-ray 3 views | CPT | 73130 | 15 | — | — | $80.45 | $191.45 | 2.1× | $543.98 |
| MRI upper extremity joint without contrast | CPT | 73221 | 15 | — | — | $490.97 | $957.58 | 2.3× | $2,772.14 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 15 | — | — | $227.32 | $1,290.05 | 2.1× | $3,619.94 |
| Knee X-ray 1-2 views | CPT | 73560 | 15 | — | — | $60.46 | $117.92 | 1.3× | $331.59 |
| Ankle X-ray 3 views | CPT | 73610 | 15 | — | — | $56.96 | $156.01 | 1.7× | $453.47 |
| MRI lower extremity joint without contrast | CPT | 73721 | 15 | — | — | $508.87 | $992.49 | 2.1× | $2,885.41 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 15 | — | — | $742.98 | $1,449.1 | 2.3× | $4,010.15 |
| CT abdomen without contrast | CPT | 74150 | 15 | — | — | $43.14 | $547.5 | 2.9× | $1,853.79 |
| CT abdomen with contrast | CPT | 74160 | 15 | — | — | $141.36 | $909.64 | 3.2× | $2,723.25 |
| CT abdomen with and without contrast | CPT | 74170 | 15 | — | — | $645.14 | $1,140.26 | 3.4× | $3,651.68 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 15 | — | — | $531.47 | $1,036.57 | 2.8× | $2,730.42 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 15 | — | — | $936.16 | $1,754.57 | 3.2× | $5,099.53 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 15 | — | — | $1,023.37 | $1,821.18 | 3.2× | $5,623.39 |
| MRI abdomen without contrast | CPT | 74181 | 15 | — | — | $591.48 | $1,014.84 | 2.6× | $3,304.91 |
| MRI abdomen with and without contrast | CPT | 74183 | 15 | — | — | $235.51 | $1,765.39 | 3.1× | $5,412.79 |
| Abdominal ultrasound complete | CPT | 76700 | 15 | — | — | $94.26 | $246.85 | 1.7× | $701.47 |
| Abdominal ultrasound limited | CPT | 76705 | 15 | — | — | $119.62 | $233.31 | 1.6× | $614.57 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 15 | — | — | $130.04 | $253.64 | 1.8× | $713.03 |
| Obstetric ultrasound first trimester | CPT | 76801 | 15 | — | — | $103.94 | $204.78 | 1.4× | $582.11 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 15 | — | — | $131 | $255.5 | 1.7× | $747.8 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 15 | — | — | $128.19 | $379.39 | 1.6× | $1,166.71 |
| Transvaginal ultrasound | CPT | 76830 | 15 | — | — | $136.15 | $265.55 | 1.8× | $738.35 |
| Pelvic ultrasound complete | CPT | 76856 | 15 | — | — | $138.75 | $274.32 | 1.9× | $804.43 |
| Scrotal ultrasound | CPT | 76870 | 15 | — | — | $75.91 | $148.05 | 1.1× | $389.99 |
| Diagnostic mammography unilateral | CPT | 77065 | 15 | — | — | $13.42 | $194.09 | 1.3× | $579.59 |
| Diagnostic mammography bilateral | CPT | 77066 | 15 | — | — | $6.79 | $248.28 | 1.3× | $801.25 |
| Screening mammography bilateral | CPT | 77067 | 15 | — | — | $109 | $254.92 | 1.6× | $709.77 |
| EKG tracing only | CPT | 93005 | 16 | — | — | $22.12 | $82.14 | 0.70× | $216.37 |
| Transthoracic echocardiogram complete | CPT | 93306 | 15 | — | — | $544.29 | $1,061.58 | 1.8× | $2,796.32 |
| Transthoracic echocardiogram | CPT | 93307 | 15 | — | — | $351.11 | $684.81 | 2.8× | $1,803.86 |
| Stress echocardiogram | CPT | 93350 | 15 | — | — | $438.16 | $854.57 | 1.7× | $2,477.95 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 16 | — | — | $25.65 | $95.25 | 2.9× | $250.9 |
| Electrolyte panel | CPT | 80051 | 16 | — | — | $8.99 | $30.26 | 1.3× | $97.74 |
| Comprehensive metabolic panel | CPT | 80053 | 16 | — | — | $34.2 | $127 | 2.9× | $334.54 |
| Lipid panel | CPT | 80061 | 16 | — | — | $11.03 | $40.98 | 1.1× | $107.94 |
| Renal function panel | CPT | 80069 | 16 | — | — | $11.13 | $40.52 | 1.5× | $108.83 |
| Hepatic function panel | CPT | 80076 | 16 | — | — | $26.99 | $100.23 | 3.8× | $264.01 |
| Urinalysis non-automated | CPT | 81002 | 15 | — | — | $6.3 | $12.3 | 1.8× | $35.99 |
| Urinalysis automated | CPT | 81003 | 16 | — | — | $2.46 | $9.14 | 0.66× | $24.07 |
| Glucose quantitative | CPT | 82947 | 16 | — | — | $5.11 | $17.84 | 1.0× | $49.94 |
| Hemoglobin A1c | CPT | 83036 | 16 | — | — | $9.16 | $35.09 | 1.3× | $122.31 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 16 | — | — | $18.42 | $68.41 | 1.4× | $180.19 |
| Complete blood count with automated differential | CPT | 85025 | 16 | — | — | $14.72 | $54.65 | 2.1× | $143.96 |
| Complete blood count without differential | CPT | 85027 | 16 | — | — | $9.9 | $36.75 | 1.7× | $96.8 |
| Urine culture bacterial | CPT | 87086 | 16 | — | — | $8.56 | $31.8 | 1.4× | $83.75 |
| Tissue exam by pathologist level IV | CPT | 88305 | 15 | — | — | $84.91 | $178.08 | 1.7× | $727.22 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 15 | — | — | $112.01 | $208.87 | 1.1× | $575.43 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 16 | — | — | $19.32 | $78.5 | 0.91× | $228.19 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 16 | — | — | $25.96 | $80.15 | 0.65× | $282.14 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 16 | — | — | $7.03 | $88.75 | 0.51× | $333.15 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 16 | — | — | $18.85 | $105.59 | 0.48× | $402.23 |
| Office visit, established patient, 5 min | CPT | 99211 | 16 | — | — | $4.21 | $58.71 | 0.91× | $171.83 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 16 | — | — | $18.19 | $61.21 | 0.77× | $186.42 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 16 | — | — | $8.52 | $84.15 | 0.73× | $221.66 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 16 | — | — | $5.9 | $81 | 0.53× | $270.59 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 16 | — | — | $31.45 | $94.89 | 0.50× | $341.84 |