| emergency |
| ED visit level 1 | CPT | 99281 | 3 | $274 | $82.2 | $110.09 | $112.34 | 0.80× | $112.34 |
| ED visit level 2 | CPT | 99282 | 3 | $390 | $117 | $156.7 | $159.9 | 0.67× | $159.9 |
| ED visit level 3 | CPT | 99283 | 3 | $1,786 | $535.8 | $717.61 | $732.26 | 1.8× | $732.26 |
| ED visit level 4 | CPT | 99284 | 3 | $2,857 | $857.1 | $1,147.94 | $1,171.37 | 1.8× | $1,171.37 |
| ED visit level 5 | CPT | 99285 | 3 | $4,491 | $1,347.3 | $1,804.48 | $1,841.31 | 1.8× | $1,841.31 |
| Critical care, first hour | CPT | 99291 | 3 | $7,160 | $2,148 | $2,876.89 | $2,935.6 | 2.7× | $2,935.6 |
| imaging |
| CT head without contrast | CPT | 70450 | 7 | $3,385 | $1,015.5 | $683.77 | $1,692.5 | 8.2× | $1,692.5 |
| CT head with contrast | CPT | 70460 | 7 | $4,127 | $1,238.1 | $833.65 | $2,063.5 | 8.8× | $2,063.5 |
| CT head with and without contrast | CPT | 70470 | 7 | $4,971 | $1,491.3 | $1,004.14 | $2,485.5 | 9.3× | $2,485.5 |
| CT neck with contrast | CPT | 70491 | 7 | $4,102 | $1,230.6 | $828.6 | $2,051 | 7.5× | $2,051 |
| MRI brain without contrast | CPT | 70551 | 7 | $3,310 | $993 | $668.62 | $1,655 | 4.1× | $1,655 |
| MRI brain with contrast | CPT | 70552 | 7 | $5,410 | $1,623 | $1,092.82 | $2,705 | 5.7× | $2,705 |
| MRI brain with and without contrast | CPT | 70553 | 7 | $6,629 | $1,988.7 | $1,339.06 | $3,314.5 | 5.6× | $3,314.5 |
| Chest X-ray single view | CPT | 71045 | 25 | $414 | $124.2 | $83.63 | $372.6 | 3.9× | $372.6 |
| Chest X-ray 2 views | CPT | 71046 | 25 | $552 | $165.6 | $111.5 | $496.8 | 5.1× | $496.8 |
| Chest X-ray 3 views | CPT | 71047 | 25 | $681 | $204.3 | $137.56 | $612.9 | 6.4× | $612.9 |
| CT chest without contrast | CPT | 71250 | 7 | $3,564 | $1,069.2 | $719.93 | $1,782 | 8.3× | $1,782 |
| CT chest with contrast | CPT | 71260 | 7 | $4,228 | $1,268.4 | $854.06 | $2,114 | 7.5× | $2,114 |
| CT chest with and without contrast | CPT | 71270 | 7 | $4,879 | $1,463.7 | $985.56 | $2,439.5 | 8.4× | $2,439.5 |
| MRI chest without contrast | CPT | 71550 | 7 | $4,191 | $1,257.3 | $846.58 | $2,095.5 | 4.9× | $2,095.5 |
| MRI chest with and without contrast | CPT | 71552 | 7 | $4,714 | $1,414.2 | $952.23 | $2,357 | 3.9× | $2,357 |
| Lumbosacral spine X-ray | CPT | 72100 | 25 | $841 | $252.3 | $169.88 | $756.9 | 7.3× | $756.9 |
| CT cervical spine without contrast | CPT | 72125 | 7 | $4,129 | $1,238.7 | $834.06 | $2,064.5 | 10.2× | $2,064.5 |
| CT thoracic spine without contrast | CPT | 72128 | 7 | $2,632 | $789.6 | $531.66 | $1,316 | 6.6× | $1,316 |
| CT lumbar spine without contrast | CPT | 72131 | 7 | $2,639 | $791.7 | $533.08 | $1,319.5 | 6.5× | $1,319.5 |
| MRI cervical spine without contrast | CPT | 72141 | 7 | $3,002 | $900.6 | $606.4 | $1,501 | 3.8× | $1,501 |
| MRI thoracic spine without contrast | CPT | 72146 | 7 | $3,150 | $945 | $636.3 | $1,575 | 4.2× | $1,575 |
| MRI lumbar spine without contrast | CPT | 72148 | 7 | $3,266 | $979.8 | $659.73 | $1,633 | 4.3× | $1,633 |
| MRI cervical spine with and without contrast | CPT | 72156 | 7 | $4,920 | $1,476 | $993.84 | $2,460 | 4.6× | $2,460 |
| MRI lumbar spine with contrast | CPT | 72158 | 7 | $4,963 | $1,488.9 | $1,002.53 | $2,481.5 | 4.5× | $2,481.5 |
| CT pelvis without contrast | CPT | 72192 | 7 | $2,831 | $849.3 | $571.86 | $1,415.5 | 7.1× | $1,415.5 |
| CT pelvis with contrast | CPT | 72193 | 7 | $4,407 | $1,322.1 | $890.21 | $2,203.5 | 7.8× | $2,203.5 |
| Shoulder X-ray | CPT | 73030 | 25 | $1,119 | $335.7 | $150.69 | $671.4 | 7.2× | $1,007.1 |
| Humerus X-ray | CPT | 73060 | 25 | $1,093.5 | $328.05 | $147.26 | $656.1 | 7.3× | $984.15 |
| Hand X-ray 3 views | CPT | 73130 | 25 | $966 | $289.8 | $130.09 | $579.6 | 6.2× | $869.4 |
| MRI upper extremity joint without contrast | CPT | 73221 | 7 | $5,772 | $1,731.6 | $777.3 | $1,924 | 4.6× | $2,886 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 7 | $4,562 | $1,368.6 | $921.52 | $2,281 | 3.7× | $2,281 |
| Knee X-ray 1-2 views | CPT | 73560 | 25 | $969 | $290.7 | $130.49 | $581.4 | 6.2× | $872.1 |
| Ankle X-ray 3 views | CPT | 73610 | 25 | $1,068 | $320.4 | $143.82 | $640.8 | 7.0× | $961.2 |
| MRI lower extremity joint without contrast | CPT | 73721 | 7 | $6,000 | $1,800 | $808 | $2,000 | 4.3× | $3,000 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 7 | $6,957 | $2,087.1 | $936.88 | $2,319 | 3.7× | $3,478.5 |
| CT abdomen without contrast | CPT | 74150 | 7 | $3,802 | $1,140.6 | $768 | $1,901 | 10.1× | $1,901 |
| CT abdomen with contrast | CPT | 74160 | 7 | $3,079 | $923.7 | $621.96 | $1,539.5 | 5.4× | $1,539.5 |
| CT abdomen with and without contrast | CPT | 74170 | 7 | $5,321 | $1,596.3 | $1,074.84 | $2,660.5 | 8.0× | $2,660.5 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 7 | $7,572 | $2,271.6 | $1,529.54 | $3,786 | 10.4× | $3,786 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 7 | $8,804 | $2,641.2 | $1,778.41 | $4,402 | 8.0× | $4,402 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 7 | $10,701 | $3,210.3 | $2,161.6 | $5,350.5 | 9.3× | $5,350.5 |
| MRI abdomen without contrast | CPT | 74181 | 7 | $3,960 | $1,188 | $799.92 | $1,980 | 5.1× | $1,980 |
| MRI abdomen with and without contrast | CPT | 74183 | 7 | $4,235 | $1,270.5 | $855.47 | $2,117.5 | 3.7× | $2,117.5 |
| Abdominal ultrasound complete | CPT | 76700 | 7 | $1,063 | $318.9 | $214.73 | $531.5 | 3.6× | $531.5 |
| Abdominal ultrasound limited | CPT | 76705 | 7 | $1,257 | $377.1 | $253.91 | $628.5 | 4.3× | $628.5 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 7 | $1,338 | $401.4 | $270.28 | $669 | 4.7× | $669 |
| Obstetric ultrasound first trimester | CPT | 76801 | 25 | $1,212 | $363.6 | $244.82 | $1,090.8 | 7.7× | $1,090.8 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 25 | $1,164 | $349.2 | $235.13 | $1,047.6 | 6.9× | $1,047.6 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 25 | $1,397 | $419.1 | $282.19 | $1,257.3 | 5.3× | $1,257.3 |
| Transvaginal ultrasound | CPT | 76830 | 25 | $1,088 | $326.4 | $219.78 | $979.2 | 6.6× | $979.2 |
| Pelvic ultrasound complete | CPT | 76856 | 7 | $1,230 | $369 | $248.46 | $615 | 4.3× | $615 |
| Scrotal ultrasound | CPT | 76870 | 7 | $817 | $245.1 | $165.03 | $408.5 | 3.1× | $408.5 |
| Diagnostic mammography unilateral | CPT | 77065 | 25 | $617 | $185.1 | $124.63 | $555.3 | 3.7× | $555.3 |
| Diagnostic mammography bilateral | CPT | 77066 | 25 | $729 | $218.7 | $147.26 | $656.1 | 3.4× | $656.1 |
| Screening mammography bilateral | CPT | 77067 | 25 | $561 | $168.3 | $113.32 | $504.9 | 3.2× | $504.9 |
| EKG tracing only | CPT | 93005 | 28 | $604 | $181.2 | $122.01 | $543.6 | 4.6× | $543.6 |
| Transthoracic echocardiogram complete | CPT | 93306 | 28 | $2,305 | $691.5 | $465.61 | $2,074.5 | 3.5× | $2,074.5 |
| Stress echocardiogram | CPT | 93350 | 28 | $1,741 | $522.3 | $351.68 | $1,566.9 | 3.1× | $1,566.9 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 25 | $516 | $154.8 | $104.23 | $464.4 | 14.3× | $464.4 |
| General health panel | CPT | 80050 | 3 | $1,473 | $441.9 | $441.9 | $441.9 | 4.1× | $441.9 |
| Electrolyte panel | CPT | 80051 | 25 | $367 | $110.1 | $74.13 | $330.3 | 13.9× | $330.3 |
| Comprehensive metabolic panel | CPT | 80053 | 25 | $663 | $198.9 | $133.93 | $596.7 | 13.4× | $596.7 |
| Lipid panel | CPT | 80061 | 25 | $329 | $98.7 | $66.46 | $296.1 | 7.8× | $296.1 |
| Renal function panel | CPT | 80069 | 25 | $515 | $154.5 | $104.03 | $463.5 | 17.0× | $463.5 |
| Hepatic function panel | CPT | 80076 | 25 | $572 | $171.6 | $115.54 | $514.8 | 19.4× | $514.8 |
| Urinalysis non-automated | CPT | 81002 | 25 | $43 | $12.9 | $8.69 | $38.7 | 5.6× | $38.7 |
| Urinalysis automated | CPT | 81003 | 25 | $81 | $24.3 | $16.36 | $72.9 | 5.2× | $72.9 |
| Glucose quantitative | CPT | 82947 | 25 | $311 | $93.3 | $62.82 | $279.9 | 15.9× | $279.9 |
| Hemoglobin A1c | CPT | 83036 | 25 | $185 | $55.5 | $37.37 | $166.5 | 6.2× | $166.5 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 25 | $469 | $140.7 | $94.74 | $422.1 | 8.9× | $422.1 |
| Complete blood count with automated differential | CPT | 85025 | 25 | $312 | $93.6 | $63.02 | $280.8 | 10.6× | $280.8 |
| Complete blood count without differential | CPT | 85027 | 25 | $158 | $47.4 | $31.92 | $142.2 | 6.6× | $142.2 |
| Urine culture bacterial | CPT | 87086 | 25 | $415 | $124.5 | $83.83 | $373.5 | 16.0× | $373.5 |
| Tissue exam by pathologist level IV | CPT | 88305 | 25 | $671 | $201.3 | $135.54 | $603.9 | 5.9× | $603.9 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 10 | $1,899 | $569.7 | $383.6 | $778.59 | 4.1× | $949.5 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 5 | $2,900 | $870 | $585.8 | $1,450 | 1.6× | $1,450 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 5 | $4,556 | $1,366.8 | $920.31 | $2,278 | 2.4× | $2,278 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 5 | $3,217 | $965.1 | $649.83 | $1,608.5 | 1.9× | $1,608.5 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 5 | $5,818 | $1,745.4 | $1,175.24 | $2,909 | 3.3× | $2,909 |
| Colonoscopy diagnostic | CPT | 45378 | 5 | $3,678 | $1,103.4 | $742.96 | $1,839 | 2.1× | $1,839 |
| Colonoscopy with biopsy | CPT | 45380 | 5 | $4,017 | $1,205.1 | $811.43 | $2,008.5 | 1.7× | $2,008.5 |
| Colonoscopy with polyp removal | CPT | 45385 | 5 | $4,045 | $1,213.5 | $817.09 | $2,022.5 | 1.7× | $2,022.5 |