| emergency |
| ED visit level 1 | CPT | 99281 | 16 | — | $149.96 | $55.94 | $620 | 4.4× | $1,160 |
| ED visit level 2 | CPT | 99282 | 16 | — | $271.81 | $120.8 | $620 | 2.6× | $1,160 |
| ED visit level 3 | CPT | 99283 | 16 | — | $478.39 | $212.62 | $1,020 | 2.5× | $1,639 |
| ED visit level 4 | CPT | 99284 | 16 | — | $751.34 | $333.93 | $1,020 | 1.5× | $1,840 |
| ED visit level 5 | CPT | 99285 | 16 | — | $1,078.49 | $479.33 | $1,159 | 1.1× | $3,220 |
| Critical care, first hour | CPT | 99291 | 17 | — | $1,430.79 | $623.19 | $1,059.5 | 0.99× | $3,680 |
| imaging |
| CT head without contrast | CPT | 70450 | 16 | — | $225.09 | $100.04 | $180 | 0.87× | $750 |
| CT head with contrast | CPT | 70460 | 16 | — | $368.81 | $156.63 | $229.48 | 0.98× | $750 |
| CT head with and without contrast | CPT | 70470 | 16 | — | $368.81 | $156.63 | $229.48 | 0.86× | $750 |
| CT neck with contrast | CPT | 70491 | 16 | — | $368.81 | $156.63 | $229.48 | 0.84× | $750 |
| MRI brain without contrast | CPT | 70551 | 17 | — | $475.35 | $207.04 | $331.18 | 0.82× | $1,269 |
| MRI brain with contrast | CPT | 70552 | 16 | — | $760.38 | $295.5 | $514.79 | 1.1× | $1,301.8 |
| MRI brain with and without contrast | CPT | 70553 | 16 | — | $760.38 | $295.5 | $536.97 | 0.91× | $1,301.8 |
| Chest X-ray single view | CPT | 71045 | 16 | — | $167.11 | $17.1 | $74.64 | 0.79× | $264.96 |
| Chest X-ray 2 views | CPT | 71046 | 16 | — | $167.11 | $31.26 | $74.64 | 0.76× | $264.96 |
| Chest X-ray 3 views | CPT | 71047 | 16 | — | $167.11 | $39.76 | $74.64 | 0.78× | $264.96 |
| CT chest without contrast | CPT | 71250 | 16 | — | $225.09 | $100.04 | $180 | 0.84× | $750 |
| CT chest with contrast | CPT | 71260 | 16 | — | $368.81 | $156.63 | $229.48 | 0.82× | $750 |
| CT chest with and without contrast | CPT | 71270 | 16 | — | $368.81 | $156.63 | $373.49 | 1.3× | $750 |
| MRI chest without contrast | CPT | 71550 | 16 | — | $475.35 | $208.84 | $424.08 | 0.99× | $1,000 |
| MRI chest with contrast | CPT | 71551 | 16 | — | $1,477.27 | $529.81 | $682.83 | 0.84× | $2,334.04 |
| MRI chest with and without contrast | CPT | 71552 | 16 | — | $760.38 | $337.95 | $591.12 | 0.98× | $2,334.04 |
| Lumbosacral spine X-ray | CPT | 72100 | 16 | — | $225.09 | $39.88 | $98.5 | 0.95× | $371.68 |
| CT cervical spine without contrast | CPT | 72125 | 16 | — | $225.09 | $100.04 | $180 | 0.89× | $750 |
| CT thoracic spine without contrast | CPT | 72128 | 16 | — | $225.09 | $100.04 | $180 | 0.90× | $750 |
| CT lumbar spine without contrast | CPT | 72131 | 16 | — | $225.09 | $100.04 | $180 | 0.89× | $750 |
| MRI cervical spine without contrast | CPT | 72141 | 16 | — | $475.35 | $208.84 | $350.6 | 0.88× | $1,000 |
| MRI thoracic spine without contrast | CPT | 72146 | 16 | — | $475.35 | $208.84 | $350.6 | 0.94× | $1,000 |
| MRI lumbar spine without contrast | CPT | 72148 | 16 | — | $475.35 | $208.84 | $350.6 | 0.93× | $1,000 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 16 | — | $760.38 | $295.5 | $515.1 | 1.1× | $1,301.8 |
| MRI cervical spine with and without contrast | CPT | 72156 | 16 | — | $760.38 | $295.5 | $536.97 | 0.99× | $1,301.8 |
| MRI lumbar spine with contrast | CPT | 72158 | 16 | — | $760.38 | $295.5 | $536.97 | 0.98× | $1,301.8 |
| CT pelvis without contrast | CPT | 72192 | 16 | — | $225.09 | $100.04 | $180 | 0.90× | $750 |
| CT pelvis with contrast | CPT | 72193 | 16 | — | $368.81 | $156.63 | $229.48 | 0.82× | $750 |
| Shoulder X-ray | CPT | 73030 | 16 | — | $167.11 | $34.57 | $71.7 | 0.77× | $264.96 |
| Humerus X-ray | CPT | 73060 | 16 | — | $167.11 | $33.51 | $71.7 | 0.80× | $264.96 |
| Hand X-ray 3 views | CPT | 73130 | 16 | — | $167.11 | $39.36 | $71.7 | 0.77× | $264.96 |
| MRI upper extremity joint without contrast | CPT | 73221 | 16 | — | $475.35 | $208.84 | $350.6 | 0.84× | $1,000 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 16 | — | $760.38 | $337.95 | $591.12 | 0.97× | $2,334.04 |
| Knee X-ray 1-2 views | CPT | 73560 | 16 | — | $167.11 | $35.64 | $71.7 | 0.77× | $264.96 |
| Ankle X-ray 3 views | CPT | 73610 | 16 | — | $167.11 | $40.96 | $71.7 | 0.78× | $264.96 |
| MRI lower extremity joint without contrast | CPT | 73721 | 16 | — | $475.35 | $208.84 | $420 | 0.90× | $1,610 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 16 | — | $760.38 | $337.95 | $814.5 | 1.3× | $4,084.8 |
| CT abdomen without contrast | CPT | 74150 | 16 | — | $225.09 | $100.04 | $180 | 0.96× | $750 |
| CT abdomen with contrast | CPT | 74160 | 16 | — | $368.81 | $156.63 | $229.48 | 0.80× | $750 |
| CT abdomen with and without contrast | CPT | 74170 | 16 | — | $368.81 | $156.63 | $404.97 | 1.2× | $750 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 16 | — | $475.35 | $176.47 | $295.78 | 0.81× | $834 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 16 | — | $760.38 | $295.5 | $473.13 | 0.86× | $1,301.8 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 16 | — | $760.38 | $295.5 | $473.13 | 0.82× | $1,301.8 |
| MRI abdomen without contrast | CPT | 74181 | 16 | — | $475.35 | $208.84 | $423.79 | 1.1× | $1,000 |
| MRI abdomen with and without contrast | CPT | 74183 | 16 | — | $760.38 | $295.5 | $546 | 0.96× | $1,301.8 |
| Abdominal ultrasound complete | CPT | 76700 | 16 | — | $225.09 | $69.96 | $140.05 | 0.94× | $400.53 |
| Abdominal ultrasound limited | CPT | 76705 | 16 | — | $225.09 | $84.37 | $116.09 | 0.79× | $400.53 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 16 | — | $225.09 | $84.37 | $130.42 | 0.91× | $400.53 |
| Obstetric ultrasound first trimester | CPT | 76801 | 17 | — | $225.09 | $69.51 | $126.92 | 0.90× | $400.53 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 17 | — | $225.09 | $69.51 | $141.37 | 0.93× | $400.53 |
| Transvaginal ultrasound | CPT | 76830 | 17 | — | $225.09 | $66.47 | $103.04 | 0.70× | $400.53 |
| Pelvic ultrasound complete | CPT | 76856 | 17 | — | $225.09 | $69.51 | $129.57 | 0.90× | $400.53 |
| Diagnostic mammography unilateral | CPT | 77065 | 14 | — | — | $54.71 | $127.33 | 0.85× | $241.04 |
| Diagnostic mammography bilateral | CPT | 77066 | 14 | — | — | $70.17 | $163.3 | 0.86× | $309.12 |
| Screening mammography bilateral | CPT | 77067 | 14 | — | — | $57.01 | $156.87 | 0.99× | $376.28 |
| EKG complete | CPT | 93000 | 15 | — | — | $15.83 | $173.7 | 7.1× | $328.81 |
| EKG tracing only | CPT | 93005 | 16 | — | $114.97 | $51.1 | $139.46 | 1.2× | $274.16 |
| Transthoracic echocardiogram complete | CPT | 93306 | 16 | — | $997.45 | $285.69 | $620.64 | 1.0× | $1,258.56 |
| Transthoracic echocardiogram | CPT | 93307 | 16 | — | $475.35 | $110.16 | $246.49 | 1.00× | $583.28 |
| Stress echocardiogram | CPT | 93350 | 16 | — | $997.45 | $205.33 | $614.54 | 1.2× | $1,693.72 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 16 | — | $19.04 | $7.3 | $12.63 | 0.39× | $34.04 |
| General health panel | CPT | 80050 | 13 | — | — | $32.05 | $74.5 | 0.69× | $137.08 |
| Electrolyte panel | CPT | 80051 | 16 | — | $15.77 | $6.05 | $10.46 | 0.44× | $27.6 |
| Comprehensive metabolic panel | CPT | 80053 | 17 | — | $23.76 | $9.11 | $17.6 | 0.40× | $42.32 |
| Lipid panel | CPT | 80061 | 15 | — | — | $11.55 | $25.18 | 0.66× | $53.36 |
| Renal function panel | CPT | 80069 | 16 | — | $19.53 | $7.49 | $12.95 | 0.47× | $34.96 |
| Hepatic function panel | CPT | 80076 | 16 | — | $18.38 | $7.05 | $14.3 | 0.54× | $30.36 |
| Urinalysis non-automated | CPT | 81002 | 16 | — | $7.83 | $2.43 | $3.95 | 0.57× | $12.88 |
| Urinalysis automated | CPT | 81003 | 17 | — | $5.06 | $1.94 | $3.32 | 0.24× | $9.2 |
| Glucose quantitative | CPT | 82947 | 15 | — | — | $3.39 | $6.54 | 0.37× | $15.64 |
| Hemoglobin A1c | CPT | 83036 | 16 | — | $21.85 | $8.38 | $14.47 | 0.54× | $38.64 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 17 | — | $37.8 | $14.5 | $27.99 | 0.59× | $67.16 |
| Complete blood count with automated differential | CPT | 85025 | 17 | — | $17.48 | $6.7 | $11.7 | 0.44× | $31 |
| Complete blood count without differential | CPT | 85027 | 17 | — | $14.56 | $5.58 | $9.74 | 0.45× | $26 |
| Urine culture bacterial | CPT | 87086 | 17 | — | $18.16 | $6.96 | $14.53 | 0.62× | $29.88 |
| Urine culture identification | CPT | 87088 | 16 | — | $18.2 | $6.98 | $12.08 | 0.54× | $27.57 |
| Tissue exam by pathologist level IV | CPT | 88305 | 17 | — | $102.78 | $26.17 | $62.65 | 0.61× | $163.76 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 16 | — | $351.81 | $152.24 | $314.2 | 1.7× | $670.68 |
| Vaginal delivery only | CPT | 59409 | 16 | — | $5,418.48 | $1,159 | $2,504.54 | 1.1× | $5,483.2 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 12 | — | — | $50.54 | $121 | 1.4× | $242 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 12 | — | — | $66.41 | $159 | 1.3× | $318 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 12 | — | — | $88.13 | $211 | 1.2× | $422 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 12 | — | — | $120.5 | $288.5 | 1.3× | $530.84 |
| Office visit, established patient, 5 min | CPT | 99211 | 15 | — | — | $11.28 | $106 | 1.6× | $3,188 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 12 | — | — | $43.65 | $117.61 | 1.5× | $242 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 12 | — | — | $43.65 | $152.23 | 1.3× | $318 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 12 | — | — | $88.13 | $211 | 1.4× | $422 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 12 | — | — | $120.5 | $288.5 | 1.5× | $530.84 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | — | $1,672.3 | $743.25 | $1,159 | 1.3× | $3,496 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | — | $1,672.3 | $743.25 | $2,051 | 2.1× | $4,917 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 16 | — | $1,639.36 | $728.6 | $1,581 | 1.9× | $3,787.94 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 16 | — | $1,639.36 | $728.6 | $1,581 | 1.8× | $5,227.55 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | — | $1,639.36 | $728.6 | $2,051 | 2.3× | $4,917 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | — | $2,141.93 | $951.97 | $2,051 | 1.7× | $4,917 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | — | $2,141.93 | $951.97 | $2,051 | 1.7× | $5,332 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 16 | — | $25,437 | $4,095 | $10,397 | 2.5× | $39,856 |
| Total hip replacement | CPT | 27130 | 16 | — | $25,437 | $4,095 | $10,297 | 2.4× | $37,875 |
| Total knee replacement | CPT | 27447 | 16 | — | $25,437 | $4,095 | $10,385 | 2.5× | $39,811 |
| Knee revision arthroplasty all components | CPT | 27487 | 16 | — | $25,437 | $4,095 | $10,297 | 5.1× | $23,653 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 16 | — | $12,941 | $3,175 | $6,376 | 1.9× | $25,307 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 16 | — | $5,846.45 | $2,403.78 | $3,430 | 1.7× | $10,590 |
| ACL reconstruction | CPT | 29888 | 16 | — | $12,941 | $3,175 | $5,981.53 | 1.8× | $27,131 |
| Laparoscopic appendectomy | CPT | 44970 | 16 | — | $10,453 | $3,175 | $5,173.86 | 3.3× | $22,126 |
| Laparoscopic cholecystectomy | CPT | 47562 | 16 | — | $10,453 | $3,175 | $4,831.51 | 2.7× | $17,773 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 16 | — | $10,453 | $3,175 | $5,018 | 2.7× | $19,958 |
| Open umbilical hernia repair | CPT | 49560 | 16 | — | $6,575.62 | $2,538 | $3,430 | 1.8× | $11,995 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 16 | — | $6,575.62 | $2,538 | $3,869.47 | 2.9× | $16,250 |
| Lap inguinal hernia repair | CPT | 49650 | 16 | — | $10,453 | $3,175 | $5,216.39 | 4.6× | $21,906 |
| Lap incisional hernia repair | CPT | 49652 | 16 | — | $10,453 | $3,175 | $5,353.38 | 2.0× | $22,482 |
| Total abdominal hysterectomy | CPT | 58150 | 14 | — | — | $3,163 | $5,733.99 | 5.9× | $24,080 |
| Vaginal hysterectomy | CPT | 58260 | 16 | — | $9,108.3 | $2,538 | $5,397.41 | 3.0× | $28,323 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 16 | — | $10,453 | $3,175 | $5,410.59 | 3.7× | $22,722 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 16 | — | $18,400 | $3,175 | $8,177.59 | 3.7× | $25,988 |
| Lap salpingo-oophorectomy | CPT | 58661 | 16 | — | $10,453 | $3,175 | $4,831.51 | 2.4× | $16,988 |
| PCI single major coronary artery | CPT | 92920 | 16 | — | $10,239 | $1,398.78 | $4,732.6 | 0.83× | $6,698 |
| PCI with drug-eluting stent | CPT | 92928 | 16 | — | $20,745 | $2,797.97 | $9,219.82 | 0.92× | $12,908 |
| PCI bypass graft | CPT | 92937 | 16 | — | $20,745 | $3,802.26 | $9,219.82 | 0.85× | $16,750 |
| Left heart catheterization | CPT | 93452 | 16 | — | $5,988.19 | $1,754.22 | $3,725.98 | 1.2× | $8,264 |
| Coronary angiography with cath | CPT | 93455 | 16 | — | $5,988.19 | $885.46 | $3,163 | 1.0× | $8,114 |
| Coronary angiography with bypass cath | CPT | 93458 | 16 | — | $5,988.19 | $1,343.44 | $4,635 | 1.5× | $16,100 |