| emergency |
| ED visit level 2 | CPT | 99282 | 6 | $617.09 | $617.09 | $431.96 | $462.82 | 2.0× | $524.53 |
| ED visit level 3 | CPT | 99283 | 6 | $1,087.21 | $1,087.21 | $761.05 | $815.41 | 2.0× | $924.13 |
| ED visit level 4 | CPT | 99284 | 6 | $1,708.99 | $1,708.99 | $1,196.29 | $1,281.74 | 1.9× | $1,452.64 |
| ED visit level 5 | CPT | 99285 | 6 | $2,453.04 | $2,453.04 | $1,717.13 | $1,839.78 | 1.8× | $2,085.08 |
| Critical care, first hour | CPT | 99291 | 6 | $3,499.4 | $3,499.4 | $2,449.58 | $2,624.55 | 2.4× | $2,974.49 |
| imaging |
| CT head without contrast | CPT | 70450 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.9× | $434.75 |
| CT head with contrast | CPT | 70460 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.7× | $713.3 |
| CT head with and without contrast | CPT | 70470 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.4× | $713.3 |
| CT neck with contrast | CPT | 70491 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.3× | $713.3 |
| MRI brain without contrast | CPT | 70551 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.0× | $918.85 |
| MRI brain with contrast | CPT | 70552 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.7× | $1,470.51 |
| MRI brain with and without contrast | CPT | 70553 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.2× | $1,470.51 |
| Chest X-ray single view | CPT | 71045 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.0× | $323.01 |
| Chest X-ray 2 views | CPT | 71046 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 2.9× | $323.01 |
| Chest X-ray 3 views | CPT | 71047 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.0× | $323.01 |
| CT chest without contrast | CPT | 71250 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.8× | $434.75 |
| CT chest with contrast | CPT | 71260 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.2× | $713.3 |
| CT chest with and without contrast | CPT | 71270 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.2× | $713.3 |
| MRI chest without contrast | CPT | 71550 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 1.9× | $918.85 |
| MRI chest with and without contrast | CPT | 71552 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.2× | $1,470.51 |
| Lumbosacral spine X-ray | CPT | 72100 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 3.7× | $434.75 |
| CT cervical spine without contrast | CPT | 72125 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.9× | $434.75 |
| CT thoracic spine without contrast | CPT | 72128 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.9× | $434.75 |
| CT lumbar spine without contrast | CPT | 72131 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.9× | $434.75 |
| MRI cervical spine without contrast | CPT | 72141 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.0× | $918.85 |
| MRI thoracic spine without contrast | CPT | 72146 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.2× | $918.85 |
| MRI lumbar spine without contrast | CPT | 72148 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.2× | $918.85 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.9× | $1,470.51 |
| MRI cervical spine with and without contrast | CPT | 72156 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.4× | $1,470.51 |
| MRI lumbar spine with contrast | CPT | 72158 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.4× | $1,470.51 |
| CT pelvis without contrast | CPT | 72192 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 1.9× | $434.75 |
| CT pelvis with contrast | CPT | 72193 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.2× | $713.3 |
| Shoulder X-ray | CPT | 73030 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.1× | $323.01 |
| Humerus X-ray | CPT | 73060 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.2× | $323.01 |
| Hand X-ray 3 views | CPT | 73130 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.1× | $323.01 |
| MRI upper extremity joint without contrast | CPT | 73221 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 1.9× | $918.85 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.1× | $1,470.51 |
| Knee X-ray 1-2 views | CPT | 73560 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.1× | $323.01 |
| Ankle X-ray 3 views | CPT | 73610 | 6 | $380.01 | $380.01 | $266.01 | $285.01 | 3.1× | $323.01 |
| MRI lower extremity joint without contrast | CPT | 73721 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 1.7× | $918.85 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.0× | $1,470.51 |
| CT abdomen without contrast | CPT | 74150 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.0× | $434.75 |
| CT abdomen with contrast | CPT | 74160 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 2.2× | $713.3 |
| CT abdomen with and without contrast | CPT | 74170 | 6 | $839.18 | $839.18 | $587.43 | $629.39 | 1.9× | $713.3 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.2× | $918.85 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.4× | $1,470.51 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.3× | $1,470.51 |
| MRI abdomen without contrast | CPT | 74181 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 2.1× | $918.85 |
| MRI abdomen with and without contrast | CPT | 74183 | 6 | $1,730.01 | $1,730.01 | $1,211.01 | $1,297.51 | 2.3× | $1,470.51 |
| Abdominal ultrasound complete | CPT | 76700 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.6× | $434.75 |
| Abdominal ultrasound limited | CPT | 76705 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.6× | $434.75 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 6 | $1,415.51 | $1,415.51 | $358.03 | $712.81 | 5.0× | $1,203.18 |
| Transvaginal ultrasound | CPT | 76830 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.6× | $434.75 |
| Pelvic ultrasound complete | CPT | 76856 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.7× | $434.75 |
| Scrotal ultrasound | CPT | 76870 | 6 | $511.47 | $511.47 | $358.03 | $383.6 | 2.9× | $434.75 |
| Screening mammography bilateral | CPT | 77067 | 6 | $609.69 | $609.69 | $426.78 | $457.27 | 2.9× | $518.24 |
| EKG tracing only | CPT | 93005 | 6 | $261.51 | $261.51 | $183.06 | $196.13 | 1.7× | $222.28 |
| Transthoracic echocardiogram complete | CPT | 93306 | 6 | $2,270.01 | $2,270.01 | $1,589.01 | $1,702.51 | 2.8× | $1,929.51 |
| Transthoracic echocardiogram | CPT | 93307 | 6 | $1,081 | $1,081 | $756.7 | $810.75 | 3.3× | $918.85 |
| Stress echocardiogram | CPT | 93350 | 6 | $2,270.01 | $2,270.01 | $1,589.01 | $1,702.51 | 3.4× | $1,929.51 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 6 | $84.6 | $84.6 | $59.22 | $63.45 | 2.0× | $71.91 |
| Electrolyte panel | CPT | 80051 | 6 | $70.1 | $70.1 | $49.07 | $52.58 | 2.2× | $59.59 |
| Comprehensive metabolic panel | CPT | 80053 | 6 | $105.6 | $105.6 | $73.92 | $79.2 | 1.8× | $89.76 |
| Lipid panel | CPT | 80061 | 6 | $61.59 | $61.59 | $43.11 | $46.19 | 1.2× | $52.35 |
| Renal function panel | CPT | 80069 | 6 | $86.8 | $86.8 | $60.76 | $65.1 | 2.4× | $73.78 |
| Hepatic function panel | CPT | 80076 | 6 | $81.7 | $81.7 | $57.19 | $61.28 | 2.3× | $69.45 |
| Urinalysis non-automated | CPT | 81002 | 6 | $34.8 | $34.8 | $24.36 | $26.1 | 3.8× | $29.58 |
| Urinalysis automated | CPT | 81003 | 6 | $22.5 | $22.5 | $15.75 | $16.88 | 1.2× | $19.13 |
| Glucose quantitative | CPT | 82947 | 6 | $18.08 | $18.08 | $12.66 | $13.56 | 0.77× | $15.37 |
| Hemoglobin A1c | CPT | 83036 | 6 | $97.1 | $97.1 | $67.97 | $72.83 | 2.7× | $82.54 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 6 | $168 | $168 | $117.6 | $126 | 2.7× | $142.8 |
| Complete blood count with automated differential | CPT | 85025 | 6 | $77.7 | $77.7 | $54.39 | $58.28 | 2.2× | $66.05 |
| Complete blood count without differential | CPT | 85027 | 6 | $64.7 | $64.7 | $45.29 | $48.53 | 2.2× | $55 |
| Urine culture bacterial | CPT | 87086 | 6 | $80.7 | $80.7 | $56.49 | $60.53 | 2.6× | $68.6 |
| Urine culture identification | CPT | 87088 | 6 | $80.9 | $80.9 | $56.63 | $60.68 | 2.7× | $68.77 |
| Tissue exam by pathologist level IV | CPT | 88305 | 6 | $233.45 | $233.45 | $163.42 | $175.09 | 1.7× | $198.43 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 6 | $3,801.39 | $3,801.39 | $2,660.97 | $2,851.04 | 3.1× | $3,231.18 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 6 | $3,801.39 | $3,801.39 | $2,660.97 | $2,851.04 | 3.0× | $3,231.18 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 6 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.3× | $3,168.98 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 6 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.1× | $3,168.98 |
| Colonoscopy diagnostic | CPT | 45378 | 6 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.2× | $3,168.98 |
| Colonoscopy with biopsy | CPT | 45380 | 6 | $4,871.68 | $4,871.68 | $3,410.18 | $3,653.76 | 3.0× | $4,140.93 |
| Colonoscopy with polyp removal | CPT | 45385 | 6 | $4,871.68 | $4,871.68 | $3,410.18 | $3,653.76 | 3.0× | $4,140.93 |