| emergency |
| ED visit level 2 | CPT | 99282 | 5 | $617.09 | $617.09 | $431.96 | $462.82 | 2.0× | $524.53 |
| ED visit level 3 | CPT | 99283 | 5 | $1,087.21 | $1,087.21 | $761.05 | $815.41 | 2.0× | $924.13 |
| ED visit level 4 | CPT | 99284 | 5 | $1,708.99 | $1,708.99 | $1,196.29 | $1,281.74 | 1.9× | $1,452.64 |
| ED visit level 5 | CPT | 99285 | 5 | $2,453.04 | $2,453.04 | $1,717.13 | $1,839.78 | 1.8× | $2,085.08 |
| Critical care, first hour | CPT | 99291 | 5 | $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 | $2,504.58 | $2,504.58 | $500 | $1,878.44 | 9.1× | $2,128.89 |
| CT head with contrast | CPT | 70460 | 6 | $2,931.08 | $2,931.08 | $500 | $2,198.31 | 9.4× | $2,491.42 |
| CT head with and without contrast | CPT | 70470 | 6 | $3,423.36 | $3,423.36 | $500 | $2,567.52 | 9.6× | $2,909.86 |
| CT neck with contrast | CPT | 70491 | 6 | $3,008.25 | $3,008.25 | $500 | $2,256.19 | 8.2× | $2,557.01 |
| MRI brain without contrast | CPT | 70551 | 6 | $3,852.86 | $3,852.86 | $1,200 | $2,889.65 | 7.2× | $3,274.93 |
| MRI brain with contrast | CPT | 70552 | 6 | $4,396.35 | $4,396.35 | $1,200 | $3,297.26 | 6.9× | $3,736.9 |
| MRI brain with and without contrast | CPT | 70553 | 6 | $5,490.78 | $5,490.78 | $1,200 | $4,118.09 | 7.0× | $4,667.16 |
| Chest X-ray single view | CPT | 71045 | 5 | $377.85 | $377.85 | $264.5 | $283.39 | 3.0× | $321.17 |
| Chest X-ray 2 views | CPT | 71046 | 5 | $455.22 | $455.22 | $318.65 | $341.42 | 3.5× | $386.94 |
| Chest X-ray 3 views | CPT | 71047 | 5 | $708.75 | $708.75 | $496.13 | $531.56 | 5.6× | $602.44 |
| CT chest without contrast | CPT | 71250 | 6 | $2,705.07 | $2,705.07 | $500 | $2,028.8 | 9.4× | $2,299.31 |
| CT chest with contrast | CPT | 71260 | 6 | $3,202.37 | $3,202.37 | $500 | $2,401.78 | 8.5× | $2,722.01 |
| CT chest with and without contrast | CPT | 71270 | 6 | $3,776.12 | $3,776.12 | $500 | $2,832.09 | 9.7× | $3,209.7 |
| MRI chest without contrast | CPT | 71550 | 6 | $3,822.53 | $3,822.53 | $1,200 | $2,866.9 | 6.7× | $3,249.15 |
| MRI chest with and without contrast | CPT | 71552 | 6 | $5,292 | $5,292 | $1,200 | $3,969 | 6.6× | $4,498.2 |
| Lumbosacral spine X-ray | CPT | 72100 | 5 | $562.01 | $562.01 | $393.41 | $421.51 | 4.1× | $477.71 |
| CT cervical spine without contrast | CPT | 72125 | 6 | $3,005.1 | $3,005.1 | $500 | $2,253.83 | 11.2× | $2,554.34 |
| CT thoracic spine without contrast | CPT | 72128 | 6 | $2,871.05 | $2,871.05 | $500 | $2,153.29 | 10.8× | $2,440.39 |
| CT lumbar spine without contrast | CPT | 72131 | 6 | $3,025.31 | $3,025.31 | $500 | $2,268.98 | 11.2× | $2,571.51 |
| MRI cervical spine without contrast | CPT | 72141 | 6 | $3,938.43 | $3,938.43 | $1,200 | $2,953.82 | 7.4× | $3,347.67 |
| MRI thoracic spine without contrast | CPT | 72146 | 6 | $3,947.97 | $3,947.97 | $1,200 | $2,960.98 | 7.9× | $3,355.77 |
| MRI lumbar spine without contrast | CPT | 72148 | 6 | $3,945.39 | $3,945.39 | $1,200 | $2,959.04 | 7.9× | $3,353.58 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 6 | $4,347.26 | $4,347.26 | $1,200 | $3,260.45 | 7.2× | $3,695.17 |
| MRI cervical spine with and without contrast | CPT | 72156 | 6 | $5,500.53 | $5,500.53 | $1,200 | $4,125.4 | 7.6× | $4,675.45 |
| MRI lumbar spine with contrast | CPT | 72158 | 6 | $5,509.56 | $5,509.56 | $1,200 | $4,132.17 | 7.5× | $4,683.13 |
| CT pelvis without contrast | CPT | 72192 | 6 | $2,667.32 | $2,667.32 | $500 | $2,000.49 | 10.0× | $2,267.22 |
| CT pelvis with contrast | CPT | 72193 | 6 | $2,800.68 | $2,800.68 | $500 | $2,100.51 | 7.5× | $2,380.58 |
| Shoulder X-ray | CPT | 73030 | 5 | $491.4 | $491.4 | $343.98 | $368.55 | 4.0× | $417.69 |
| Humerus X-ray | CPT | 73060 | 5 | $439.94 | $439.94 | $307.96 | $329.96 | 3.7× | $373.95 |
| Hand X-ray 3 views | CPT | 73130 | 5 | $462.53 | $462.53 | $323.77 | $346.9 | 3.7× | $393.15 |
| MRI upper extremity joint without contrast | CPT | 73221 | 6 | $4,998.74 | $4,998.74 | $1,200 | $3,749.06 | 9.0× | $4,248.93 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 6 | $4,992.75 | $4,992.75 | $1,200 | $3,744.56 | 6.1× | $4,243.84 |
| Knee X-ray 1-2 views | CPT | 73560 | 5 | $426.51 | $426.51 | $298.56 | $319.88 | 3.4× | $362.53 |
| Ankle X-ray 3 views | CPT | 73610 | 5 | $472.5 | $472.5 | $330.75 | $354.38 | 3.8× | $401.63 |
| MRI lower extremity joint without contrast | CPT | 73721 | 6 | $3,685.47 | $3,685.47 | $1,200 | $2,764.1 | 5.9× | $3,132.65 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 6 | $5,027.4 | $5,027.4 | $1,200 | $3,770.55 | 5.9× | $4,273.29 |
| CT abdomen without contrast | CPT | 74150 | 6 | $2,754.84 | $2,754.84 | $500 | $2,066.13 | 11.0× | $2,341.61 |
| CT abdomen with contrast | CPT | 74160 | 6 | $3,298.05 | $3,298.05 | $500 | $2,473.54 | 8.6× | $2,803.34 |
| CT abdomen with and without contrast | CPT | 74170 | 6 | $3,898.14 | $3,898.14 | $500 | $2,923.61 | 8.7× | $3,313.42 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 6 | $1,058.59 | $1,058.59 | $500 | $793.94 | 2.2× | $899.8 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 6 | $7,147.57 | $7,147.57 | $500 | $5,360.68 | 9.8× | $6,075.43 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 6 | $1,750 | $1,750 | $500 | $1,312.5 | 2.3× | $1,487.5 |
| MRI abdomen without contrast | CPT | 74181 | 6 | $3,532.01 | $3,532.01 | $1,200 | $2,649.01 | 6.8× | $3,002.21 |
| MRI abdomen with and without contrast | CPT | 74183 | 6 | $5,263.52 | $5,263.52 | $1,200 | $3,947.64 | 7.0× | $4,473.99 |
| Abdominal ultrasound complete | CPT | 76700 | 5 | $1,292.94 | $1,292.94 | $905.06 | $969.71 | 6.5× | $1,099 |
| Abdominal ultrasound limited | CPT | 76705 | 5 | $953.49 | $953.49 | $667.44 | $715.12 | 4.9× | $810.47 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 5 | $1,415.51 | $1,415.51 | $748.69 | $950 | 6.6× | $1,203.18 |
| Transvaginal ultrasound | CPT | 76830 | 5 | $902.48 | $902.48 | $631.74 | $676.86 | 4.6× | $767.11 |
| Pelvic ultrasound complete | CPT | 76856 | 5 | $1,055.82 | $1,055.82 | $739.07 | $791.87 | 5.5× | $897.45 |
| Scrotal ultrasound | CPT | 76870 | 5 | $971.33 | $971.33 | $679.93 | $728.5 | 5.6× | $825.63 |
| Screening mammography bilateral | CPT | 77067 | 5 | $444.59 | $444.59 | $311.21 | $333.44 | 2.1× | $377.9 |
| EKG tracing only | CPT | 93005 | 5 | $250 | $250 | $175 | $187.5 | 1.6× | $212.5 |
| Transthoracic echocardiogram complete | CPT | 93306 | 5 | $590.63 | $590.63 | $413.44 | $442.97 | 0.74× | $502.04 |
| Transthoracic echocardiogram | CPT | 93307 | 5 | $1,577 | $1,577 | $1,103.9 | $1,182.75 | 4.8× | $1,340.45 |
| Stress echocardiogram | CPT | 93350 | 5 | $2,229.87 | $2,229.87 | $1,560.91 | $1,672.4 | 3.3× | $1,895.39 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $251.88 | $251.88 | $176.32 | $188.91 | 5.8× | $214.1 |
| Electrolyte panel | CPT | 80051 | 5 | $185.45 | $185.45 | $129.82 | $139.09 | 5.8× | $157.63 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $344.28 | $344.28 | $241 | $258.21 | 5.8× | $292.64 |
| Lipid panel | CPT | 80061 | 5 | $242.16 | $242.16 | $169.51 | $181.62 | 4.8× | $205.84 |
| Renal function panel | CPT | 80069 | 5 | $100 | $100 | $70 | $75 | 2.7× | $85 |
| Hepatic function panel | CPT | 80076 | 5 | $253.58 | $253.58 | $177.51 | $190.19 | 7.1× | $215.54 |
| Urinalysis non-automated | CPT | 81002 | 5 | $50.12 | $50.12 | $35.08 | $37.59 | 5.4× | $42.6 |
| Urinalysis automated | CPT | 81003 | 5 | $100 | $100 | $70 | $75 | 5.4× | $85 |
| Glucose quantitative | CPT | 82947 | 5 | $85.04 | $85.04 | $59.53 | $63.78 | 3.6× | $72.28 |
| Hemoglobin A1c | CPT | 83036 | 5 | $149.48 | $149.48 | $104.64 | $112.11 | 4.2× | $127.06 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $237.05 | $237.05 | $165.94 | $177.79 | 3.8× | $201.49 |
| Complete blood count with automated differential | CPT | 85025 | 5 | $153.35 | $153.35 | $107.35 | $115.01 | 4.3× | $130.35 |
| Complete blood count without differential | CPT | 85027 | 5 | $64.7 | $64.7 | $45.29 | $48.53 | 2.2× | $55 |
| Urine culture bacterial | CPT | 87086 | 5 | $170.37 | $170.37 | $119.26 | $127.78 | 5.5× | $144.81 |
| Urine culture identification | CPT | 87088 | 5 | $133.49 | $133.49 | $93.44 | $100.12 | 4.5× | $113.47 |
| Tissue exam by pathologist level IV | CPT | 88305 | 5 | $228.89 | $228.89 | $160.22 | $171.67 | 1.7× | $194.56 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 5 | $3,801.39 | $3,801.39 | $2,660.97 | $2,851.04 | 3.1× | $3,231.18 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 5 | $3,801.39 | $3,801.39 | $2,660.97 | $2,851.04 | 3.0× | $3,231.18 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 5 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.3× | $3,168.98 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 5 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.1× | $3,168.98 |
| Colonoscopy diagnostic | CPT | 45378 | 5 | $3,728.21 | $3,728.21 | $2,609.75 | $2,796.16 | 3.2× | $3,168.98 |
| Colonoscopy with biopsy | CPT | 45380 | 5 | $4,871.68 | $4,871.68 | $3,410.18 | $3,653.76 | 3.0× | $4,140.93 |
| Colonoscopy with polyp removal | CPT | 45385 | 5 | $4,871.68 | $4,871.68 | $3,410.18 | $3,653.76 | 3.0× | $4,140.93 |