| emergency |
| ED visit level 1 | CPT | 99281 | 20 | — | $77.3 | $42.97 | $80.17 | 0.57× | $135 |
| ED visit level 2 | CPT | 99282 | 20 | — | $120.05 | $77.89 | $133.47 | 0.56× | $199.8 |
| ED visit level 3 | CPT | 99283 | 20 | — | $207.7 | $135 | $230.39 | 0.57× | $345.6 |
| ED visit level 4 | CPT | 99284 | 20 | — | $368.85 | $135 | $401.36 | 0.60× | $613.8 |
| ED visit level 5 | CPT | 99285 | 20 | — | $539.7 | $72.62 | $200 | 0.19× | $898.2 |
| Critical care, first hour | CPT | 99291 | 20 | — | $1,491 | $135 | $1,378.5 | 1.3× | $2,481.3 |
| imaging |
| CT head without contrast | CPT | 70450 | 20 | — | $719.25 | $64.5 | $665 | 3.2× | $1,197 |
| CT head with contrast | CPT | 70460 | 20 | — | $870.7 | $105.68 | $805 | 3.4× | $1,449 |
| CT head with and without contrast | CPT | 70470 | 20 | — | $1,440.7 | $105.68 | $1,332 | 5.0× | $2,397.6 |
| CT neck with contrast | CPT | 70491 | 20 | — | $956.1 | $105.68 | $884 | 3.2× | $1,591.2 |
| MRI brain without contrast | CPT | 70551 | 20 | — | $1,781.4 | $136.21 | $1,921.87 | 4.8× | $2,964.6 |
| MRI brain with contrast | CPT | 70552 | 20 | — | $1,836 | $217.89 | $1,577.66 | 3.3× | $3,055.5 |
| MRI brain with and without contrast | CPT | 70553 | 20 | — | $1,979.85 | $217.89 | $1,774.64 | 3.0× | $3,294.9 |
| Chest X-ray single view | CPT | 71045 | 20 | — | $77.9 | $31.23 | $70.4 | 0.74× | $129.6 |
| Chest X-ray 2 views | CPT | 71046 | 20 | — | $168.15 | $35.95 | $79.84 | 0.81× | $279.9 |
| Chest X-ray 3 views | CPT | 71047 | 20 | — | $179.55 | $47.89 | $166 | 1.7× | $298.8 |
| CT chest without contrast | CPT | 71250 | 20 | — | $687.9 | $64.5 | $648.37 | 3.0× | $1,144.8 |
| CT chest with contrast | CPT | 71260 | 20 | — | $837.7 | $105.68 | $774.5 | 2.8× | $1,394.1 |
| CT chest with and without contrast | CPT | 71270 | 20 | — | $922.6 | $105.68 | $853 | 2.9× | $1,535.4 |
| MRI chest without contrast | CPT | 71550 | 20 | — | $1,440.15 | $136.21 | $1,148.95 | 2.7× | $2,396.7 |
| MRI chest with contrast | CPT | 71551 | 20 | — | $913.95 | $364.55 | $743.88 | 0.91× | $1,690 |
| MRI chest with and without contrast | CPT | 71552 | 20 | — | $959.4 | $217.89 | $892.9 | 1.5× | $1,774 |
| Lumbosacral spine X-ray | CPT | 72100 | 20 | — | $128.7 | $23.96 | $64.84 | 0.63× | $214.2 |
| CT cervical spine without contrast | CPT | 72125 | 20 | — | $1,257.35 | $64.5 | $1,162.5 | 5.8× | $2,092.5 |
| CT thoracic spine without contrast | CPT | 72128 | 20 | — | $672.8 | $64.5 | $622 | 3.1× | $1,119.6 |
| CT lumbar spine without contrast | CPT | 72131 | 20 | — | $1,034.55 | $64.5 | $956.5 | 4.7× | $1,721.7 |
| MRI cervical spine without contrast | CPT | 72141 | 20 | — | $1,602.95 | $136.21 | $1,728.68 | 4.4× | $2,667.6 |
| MRI thoracic spine without contrast | CPT | 72146 | 20 | — | $1,602.95 | $136.21 | $1,728.68 | 4.6× | $2,667.6 |
| MRI lumbar spine without contrast | CPT | 72148 | 20 | — | $1,602.95 | $136.21 | $1,728.68 | 4.6× | $2,667.6 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 20 | — | $1,759.8 | $217.89 | $1,577.66 | 3.5× | $2,928.6 |
| MRI cervical spine with and without contrast | CPT | 72156 | 20 | — | $1,572.65 | $217.89 | $1,696.19 | 3.1× | $2,617.2 |
| MRI lumbar spine with contrast | CPT | 72158 | 20 | — | $1,529.95 | $217.89 | $1,643.02 | 3.0× | $2,546.1 |
| CT pelvis without contrast | CPT | 72192 | 20 | — | $634.9 | $64.5 | $581.88 | 2.9× | $1,056.6 |
| CT pelvis with contrast | CPT | 72193 | 20 | — | $683 | $105.68 | $743.28 | 2.6× | $1,136.7 |
| Shoulder X-ray | CPT | 73030 | 20 | — | $221.2 | $23.96 | $60.2 | 0.65× | $368.1 |
| Humerus X-ray | CPT | 73060 | 20 | — | $151.4 | $23.96 | $60.2 | 0.67× | $252 |
| Hand X-ray 3 views | CPT | 73130 | 20 | — | $207.1 | $23.96 | $60.2 | 0.65× | $344.7 |
| MRI upper extremity joint without contrast | CPT | 73221 | 20 | — | $1,360.1 | $136.21 | $1,284.45 | 3.1× | $2,263.5 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 20 | — | $1,759.8 | $217.89 | $1,662.32 | 2.7× | $2,928.6 |
| Hip X-ray 2 views | CPT | 73510 | 17 | — | $166.55 | $23.96 | $85.62 | 1.1× | $277.2 |
| Knee X-ray 1-2 views | CPT | 73560 | 20 | — | $114.1 | $23.96 | $56.1 | 0.60× | $189.9 |
| Ankle X-ray 3 views | CPT | 73610 | 20 | — | $214.15 | $23.96 | $60.2 | 0.65× | $356.4 |
| MRI lower extremity joint without contrast | CPT | 73721 | 20 | — | $1,360.1 | $136.21 | $1,363.02 | 2.9× | $2,263.5 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 20 | — | $1,068.6 | $217.89 | $908.75 | 1.4× | $1,778.4 |
| CT abdomen without contrast | CPT | 74150 | 20 | — | $748.5 | $64.5 | $603.39 | 3.2× | $1,245.6 |
| CT abdomen with contrast | CPT | 74160 | 20 | — | $791.75 | $105.68 | $861.56 | 3.0× | $1,317.6 |
| CT abdomen with and without contrast | CPT | 74170 | 20 | — | $1,117.85 | $105.68 | $1,075.12 | 3.2× | $1,860.3 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 20 | — | $580.25 | $136.21 | $579.76 | 1.6× | $965.7 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 20 | — | $815.5 | $217.89 | $887.46 | 1.6× | $1,357.2 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 20 | — | $973.45 | $217.89 | $1,059.3 | 1.8× | $1,620 |
| MRI abdomen without contrast | CPT | 74181 | 20 | — | $1,440.15 | $136.21 | $1,360.11 | 3.5× | $2,396.7 |
| MRI abdomen with and without contrast | CPT | 74183 | 20 | — | $1,654.85 | $217.89 | $1,541.51 | 2.7× | $2,754 |
| Abdominal ultrasound complete | CPT | 76700 | 20 | — | $592.2 | $64.5 | $621.52 | 4.2× | $985.5 |
| Abdominal ultrasound limited | CPT | 76705 | 20 | — | $522.4 | $64.5 | $395.01 | 2.7× | $869.4 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 20 | — | $438.55 | $64.5 | $355 | 2.5× | $729.9 |
| Obstetric ultrasound first trimester | CPT | 76801 | 20 | — | $411 | $50.83 | $131.4 | 0.93× | $684 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 20 | — | $590.55 | $50.83 | $146 | 0.96× | $982.8 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 20 | — | $774.45 | $136.21 | $441.64 | 1.9× | $1,288.8 |
| Transvaginal ultrasound | CPT | 76830 | 20 | — | $168.75 | $50.83 | $126.7 | 0.86× | $312 |
| Pelvic ultrasound complete | CPT | 76856 | 20 | — | $256.35 | $50.83 | $145.2 | 1.0× | $426.6 |
| Scrotal ultrasound | CPT | 76870 | 20 | — | $720.9 | $64.5 | $757.41 | 5.8× | $1,199.7 |
| Diagnostic mammography unilateral | CPT | 77065 | 20 | — | $269.9 | $54.36 | $293.66 | 2.0× | $480.67 |
| Diagnostic mammography bilateral | CPT | 77066 | 20 | — | $345 | $69.47 | $375.46 | 2.0× | $612.79 |
| Screening mammography bilateral | CPT | 77067 | 20 | — | $269.3 | $57.47 | $273.9 | 1.7× | $498 |
| EKG complete | CPT | 93000 | 17 | — | $32.45 | $15.23 | $29.64 | 1.2× | $54 |
| EKG tracing only | CPT | 93005 | 20 | — | $98.95 | $12.07 | $45.5 | 0.39× | $164.7 |
| Transthoracic echocardiogram complete | CPT | 93306 | 20 | — | $625.7 | $205.51 | $453.86 | 0.76× | $1,041.3 |
| Transthoracic echocardiogram | CPT | 93307 | 20 | — | $280.7 | $136.21 | $291.81 | 1.2× | $467.1 |
| Stress echocardiogram | CPT | 93350 | 20 | — | $306.05 | $121.64 | $303.86 | 0.60× | $509.4 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 20 | — | $15.7 | $5.03 | $16.51 | 0.51× | $29 |
| General health panel | CPT | 80050 | 17 | — | $60.6 | $33.08 | $69.16 | 0.64× | $112 |
| Electrolyte panel | CPT | 80051 | 20 | — | $13 | $4.17 | $13.66 | 0.57× | $21.6 |
| Comprehensive metabolic panel | CPT | 80053 | 20 | — | $25.95 | $6.28 | $27.33 | 0.62× | $48 |
| Lipid panel | CPT | 80061 | 20 | — | $23.25 | $7.97 | $23.3 | 0.61× | $39.85 |
| Renal function panel | CPT | 80069 | 20 | — | $18.4 | $5.16 | $19.36 | 0.71× | $34 |
| Hepatic function panel | CPT | 80076 | 20 | — | $19.45 | $4.86 | $20.5 | 0.77× | $32.4 |
| Urinalysis non-automated | CPT | 81002 | 20 | — | $13 | $2.07 | $5.67 | 0.81× | $21.6 |
| Urinalysis automated | CPT | 81003 | 20 | — | $14.6 | $1.34 | $4.73 | 0.34× | $24.3 |
| Glucose quantitative | CPT | 82947 | 20 | — | $11.9 | $2.34 | $10.35 | 0.59× | $19.8 |
| Hemoglobin A1c | CPT | 83036 | 20 | — | $30.25 | $5.78 | $15.57 | 0.58× | $50.4 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 20 | — | $57.9 | $10 | $50.89 | 1.1× | $96.3 |
| Complete blood count with automated differential | CPT | 85025 | 20 | — | $34.05 | $4.62 | $14.88 | 0.56× | $56.7 |
| Complete blood count without differential | CPT | 85027 | 20 | — | $15.7 | $3.85 | $16.32 | 0.75× | $26.1 |
| Urine culture bacterial | CPT | 87086 | 20 | — | $41.65 | $4.8 | $36.62 | 1.6× | $69.3 |
| Urine culture identification | CPT | 87088 | 20 | — | $32.45 | $4.81 | $28.54 | 1.3× | $54 |
| Tissue exam by pathologist level IV | CPT | 88305 | 20 | — | $107.05 | $29.46 | $112.71 | 1.1× | $178.2 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 20 | — | $262.8 | $24.94 | $130.28 | 0.69× | $486 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 17 | — | $4,149.55 | $2,561.31 | $4,749.77 | 2.1× | $7,673 |
| office |
| Office visit, new patient, 15-29 min | CPT | 99202 | 15 | — | $445.05 | $36.31 | $79.82 | 0.93× | $740.7 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 15 | — | $473.2 | $43.21 | $95.18 | 0.78× | $787.5 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 15 | — | $500.75 | $50.47 | $108.58 | 0.62× | $833.4 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 15 | — | $531.1 | $54.83 | $128.32 | 0.58× | $883.8 |
| Office visit, established patient, 5 min | CPT | 99211 | 15 | — | $417.5 | $7.99 | $67.2 | 1.0× | $694.8 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 15 | — | $445.05 | $36.31 | $77.69 | 0.97× | $740.7 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 17 | — | $473.2 | $18.16 | $84.32 | 0.74× | $787.5 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 15 | — | $500.75 | $48.29 | $98 | 0.64× | $833.4 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 15 | — | $531.1 | $51.56 | $108.97 | 0.58× | $883.8 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 20 | — | $1,142.2 | $135 | $1,242.91 | 1.4× | $1,900.8 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 20 | — | $1,246 | $135 | $1,355.9 | 1.4× | $2,073.6 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 20 | — | $429.95 | $288.66 | $490.91 | 0.58× | $804.99 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 20 | — | $2,273.55 | $469.76 | $2,051.19 | 2.3× | $4,092.38 |
| Colonoscopy diagnostic | CPT | 45378 | 20 | — | $811.2 | $469.76 | $882.75 | 1.0× | $1,500 |
| Colonoscopy with biopsy | CPT | 45380 | 20 | — | $6,165.19 | $613.77 | $1,921.17 | 1.6× | $11,097 |
| Colonoscopy with polyp removal | CPT | 45385 | 20 | — | $1,234.98 | $613.77 | $1,453.57 | 1.2× | $2,469.96 |
| surgery |
| Total hip replacement | CPT | 27130 | 20 | — | $21,083 | $7,289.07 | $23,191 | 5.3× | $38,606 |
| Total knee replacement | CPT | 27447 | 20 | — | $17,590 | $7,289.07 | $19,349 | 4.6× | $35,180 |
| Knee revision arthroplasty single component | CPT | 27486 | 20 | — | $12,848 | $7,289.07 | $12,491 | 7.5× | $23,126 |
| Knee revision arthroplasty all components | CPT | 27487 | 20 | — | $35,703 | $7,289.07 | $32,211 | 16.1× | $64,266 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 20 | — | $13,836 | $3,708.21 | $12,483 | 3.8× | $24,905 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 20 | — | $8,631.93 | $1,675.31 | $7,787.72 | 3.8× | $15,537 |
| ACL reconstruction | CPT | 29888 | 20 | — | $18,385 | $3,708.21 | $16,587 | 5.0× | $33,093 |
| Open appendectomy | CPT | 44950 | 20 | — | $11,687 | $1,884.26 | $10,544 | 9.3× | $21,036 |
| Laparoscopic appendectomy | CPT | 44970 | 20 | — | $12,601 | $2,995.26 | $13,861 | 8.9× | $22,682 |
| Laparoscopic cholecystectomy | CPT | 47562 | 20 | — | $13,279 | $2,995.26 | $12,899 | 7.3× | $23,902 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 20 | — | $11,420 | $2,995.26 | $10,303 | 5.5× | $20,557 |
| Open umbilical hernia repair | CPT | 49560 | 20 | — | $7,525.41 | $1,884.26 | $6,789.42 | 3.6× | $13,546 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 20 | — | $8,406.6 | $1,884.26 | $7,584.43 | 5.8× | $15,132 |
| Lap inguinal hernia repair | CPT | 49650 | 20 | — | $11,452 | $2,995.26 | $10,332 | 9.2× | $20,614 |
| Lap incisional hernia repair | CPT | 49652 | 20 | — | $12,988 | $2,995.26 | $11,718 | 4.3× | $23,379 |
| Total abdominal hysterectomy | CPT | 58150 | 17 | — | $15,167 | $2,496 | $17,852 | 18.3× | $27,301 |
| Vaginal hysterectomy | CPT | 58260 | 20 | — | $11,704 | $2,610 | $10,560 | 5.8× | $21,068 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 20 | — | $13,202 | $2,995.26 | $11,911 | 8.1× | $23,764 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 20 | — | $15,363 | $5,272.42 | $13,860 | 6.2× | $27,653 |
| Lap salpingo-oophorectomy | CPT | 58661 | 20 | — | $10,201 | $2,995.26 | $9,202.92 | 4.5× | $18,361 |
| Complex cataract surgery | CPT | 66982 | 20 | — | $5,587.57 | $1,230.65 | $5,041.1 | 2.3× | $10,058 |
| Cataract surgery with lens implant | CPT | 66984 | 20 | — | $5,105.33 | $1,230.65 | $4,805 | 2.2× | $9,189.59 |
| PCI single major coronary artery | CPT | 92920 | 20 | — | $3,679.6 | $223.99 | $4,035.45 | 0.71× | $6,804 |
| PCI with drug-eluting stent | CPT | 92928 | 20 | — | $7,179.65 | $248.37 | $7,874 | 0.79× | $11,948 |
| PCI bypass graft | CPT | 92937 | 20 | — | $7,179.65 | $247.72 | $7,874 | 0.72× | $11,948 |
| Left heart catheterization | CPT | 93452 | 20 | — | $3,467.6 | $1,255.68 | $3,206 | 1.0× | $6,412 |
| Coronary angiography with cath | CPT | 93455 | 20 | — | $3,467.6 | $1,412.48 | $3,206 | 1.0× | $6,412 |
| Coronary angiography with bypass cath | CPT | 93458 | 20 | — | $4,638.95 | $135 | $1,768.05 | 0.57× | $7,720.2 |