| emergency |
| ED visit level 1 | CPT | 99281 | 7 | $162 | $162 | $49 | $113 | 0.81× | $162 |
| ED visit level 2 | CPT | 99282 | 7 | $293 | $293 | $88 | $205 | 0.86× | $293 |
| ED visit level 3 | CPT | 99283 | 7 | $517 | $517 | $155 | $362 | 0.89× | $517 |
| ED visit level 4 | CPT | 99284 | 7 | $819 | $819 | $246 | $573 | 0.86× | $819 |
| ED visit level 5 | CPT | 99285 | 7 | $1,195 | $1,195 | $359 | $837 | 0.80× | $1,195 |
| Critical care, first hour | CPT | 99291 | 7 | $2,195 | $2,195 | $659 | $1,537 | 1.4× | $2,195 |
| imaging |
| CT head without contrast | CPT | 70450 | 7 | $840 | $840 | $252 | $588 | 2.8× | $840 |
| CT head with contrast | CPT | 70460 | 7 | $1,024 | $1,024 | $307 | $717 | 3.1× | $1,024 |
| CT head with and without contrast | CPT | 70470 | 7 | $1,233 | $1,233 | $370 | $863 | 3.2× | $1,233 |
| CT neck with contrast | CPT | 70491 | 7 | $1,376 | $1,376 | $413 | $963 | 3.5× | $1,376 |
| MRI brain without contrast | CPT | 70551 | 7 | $1,430 | $1,430 | $429 | $1,001 | 2.5× | $1,430 |
| MRI brain with and without contrast | CPT | 70553 | 7 | $2,410 | $2,410 | $723 | $1,687 | 2.9× | $2,410 |
| Chest X-ray single view | CPT | 71045 | 7 | $98 | $98 | $29 | $69 | 0.73× | $98 |
| Chest X-ray 2 views | CPT | 71046 | 7 | $134 | $134 | $40 | $94 | 0.96× | $134 |
| Chest X-ray 3 views | CPT | 71047 | 7 | $170 | $170 | $51 | $119 | 1.2× | $170 |
| CT chest without contrast | CPT | 71250 | 7 | $1,073 | $1,073 | $322 | $751 | 3.5× | $1,073 |
| CT chest with contrast | CPT | 71260 | 7 | $1,385 | $1,385 | $416 | $969 | 3.4× | $1,385 |
| CT chest with and without contrast | CPT | 71270 | 7 | $1,706 | $1,706 | $512 | $1,194 | 4.1× | $1,706 |
| Lumbosacral spine X-ray | CPT | 72100 | 7 | $168 | $168 | $50 | $118 | 1.1× | $168 |
| CT cervical spine without contrast | CPT | 72125 | 7 | $1,226 | $1,226 | $368 | $858 | 4.3× | $1,226 |
| CT thoracic spine without contrast | CPT | 72128 | 7 | $1,222 | $1,222 | $367 | $855 | 4.3× | $1,222 |
| CT lumbar spine without contrast | CPT | 72131 | 7 | $1,215 | $1,215 | $365 | $851 | 4.2× | $1,215 |
| MRI cervical spine without contrast | CPT | 72141 | 7 | $1,373 | $1,373 | $412 | $961 | 2.4× | $1,373 |
| MRI thoracic spine without contrast | CPT | 72146 | 7 | $1,376 | $1,376 | $413 | $963 | 2.6× | $1,376 |
| MRI lumbar spine without contrast | CPT | 72148 | 7 | $1,376 | $1,376 | $413 | $963 | 2.6× | $1,376 |
| MRI cervical spine with and without contrast | CPT | 72156 | 7 | $2,433 | $2,433 | $730 | $1,703 | 3.2× | $2,433 |
| MRI lumbar spine with contrast | CPT | 72158 | 7 | $2,427 | $2,427 | $728 | $1,699 | 3.1× | $2,427 |
| CT pelvis without contrast | CPT | 72192 | 7 | $882 | $882 | $265 | $617 | 3.1× | $882 |
| CT pelvis with contrast | CPT | 72193 | 7 | $1,869 | $1,869 | $561 | $1,308 | 4.6× | $1,869 |
| Shoulder X-ray | CPT | 73030 | 7 | $145 | $145 | $44 | $102 | 1.1× | $145 |
| Humerus X-ray | CPT | 73060 | 7 | $140 | $140 | $42 | $98 | 1.1× | $140 |
| Hand X-ray 3 views | CPT | 73130 | 7 | $162 | $162 | $49 | $113 | 1.2× | $162 |
| MRI upper extremity joint without contrast | CPT | 73221 | 7 | $1,550 | $1,550 | $465 | $1,085 | 2.6× | $1,550 |
| Knee X-ray 1-2 views | CPT | 73560 | 7 | $153 | $153 | $46 | $107 | 1.1× | $153 |
| Ankle X-ray 3 views | CPT | 73610 | 7 | $164 | $164 | $49 | $115 | 1.2× | $164 |
| MRI lower extremity joint without contrast | CPT | 73721 | 7 | $1,550 | $1,550 | $465 | $1,085 | 2.3× | $1,550 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 7 | $1,091 | $1,091 | $327 | $764 | 2.1× | $1,091 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 7 | $2,370 | $2,370 | $711 | $1,659 | 3.0× | $2,370 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 7 | $2,679 | $2,679 | $804 | $1,875 | 3.3× | $2,679 |
| MRI abdomen with and without contrast | CPT | 74183 | 7 | $2,824 | $2,824 | $847 | $1,977 | 3.5× | $2,824 |
| Abdominal ultrasound complete | CPT | 76700 | 7 | $468 | $468 | $140 | $328 | 2.2× | $468 |
| Abdominal ultrasound limited | CPT | 76705 | 7 | $352 | $352 | $106 | $246 | 1.7× | $352 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 7 | $435 | $435 | $131 | $305 | 2.1× | $435 |
| Transvaginal ultrasound | CPT | 76830 | 7 | $512 | $512 | $154 | $358 | 2.4× | $512 |
| Pelvic ultrasound complete | CPT | 76856 | 7 | $431 | $431 | $129 | $302 | 2.1× | $431 |
| Scrotal ultrasound | CPT | 76870 | 7 | $418 | $418 | $125 | $293 | 2.2× | $418 |
| Diagnostic mammography unilateral | CPT | 77065 | 7 | $524 | $524 | $157 | $367 | 2.5× | $524 |
| Diagnostic mammography bilateral | CPT | 77066 | 7 | $670 | $670 | $201 | $469 | 2.5× | $670 |
| Screening mammography bilateral | CPT | 77067 | 7 | $555 | $555 | $167 | $389 | 2.5× | $555 |
| EKG complete | CPT | 93000 | 7 | $137 | $137 | $41 | $98 | 4.0× | $137 |
| EKG tracing only | CPT | 93005 | 7 | $87 | $87 | $26 | $61 | 0.52× | $87 |
| Transthoracic echocardiogram complete | CPT | 93306 | 7 | $749 | $749 | $225 | $524 | 0.87× | $749 |
| inpatient |
| COPD w MCC | MS-DRG | 190 | 7 | $29 | $29 | $9 | $28.5 | 0.00× | $6,241 |
| COPD w/o CC/MCC | MS-DRG | 192 | 7 | $29 | $29 | $9 | $28.5 | 0.00× | $6,241 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 7 | $29 | $29 | $9 | $28.5 | 0.00× | $6,241 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 7 | $55 | $55 | $17 | $39 | 1.2× | $55 |
| General health panel | CPT | 80050 | 7 | $222 | $222 | $67 | $155 | 1.4× | $222 |
| Comprehensive metabolic panel | CPT | 80053 | 7 | $69 | $69 | $21 | $48 | 1.1× | $69 |
| Lipid panel | CPT | 80061 | 7 | $88 | $88 | $26 | $62 | 1.6× | $88 |
| Renal function panel | CPT | 80069 | 7 | $56 | $56 | $17 | $39 | 1.4× | $56 |
| Hepatic function panel | CPT | 80076 | 7 | $53 | $53 | $16 | $37 | 1.4× | $53 |
| Urinalysis automated | CPT | 81003 | 7 | $15 | $15 | $5 | $11 | 0.79× | $15 |
| Glucose quantitative | CPT | 82947 | 7 | $26 | $26 | $8 | $18 | 1.0× | $26 |
| Hemoglobin A1c | CPT | 83036 | 7 | $63 | $63 | $19 | $44 | 1.6× | $63 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 7 | $111 | $111 | $33 | $78 | 1.6× | $111 |
| Complete blood count with automated differential | CPT | 85025 | 7 | $51 | $51 | $15 | $36 | 1.4× | $51 |
| Complete blood count without differential | CPT | 85027 | 7 | $42 | $42 | $13 | $29 | 1.3× | $42 |
| Urine culture bacterial | CPT | 87086 | 7 | $53 | $53 | $16 | $37 | 1.6× | $53 |
| Urine culture identification | CPT | 87088 | 7 | $53 | $53 | $16 | $37 | 1.7× | $53 |
| Tissue exam by pathologist level IV | CPT | 88305 | 7 | $109 | $109 | $33 | $76 | 0.74× | $109 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 7 | $48 | $48 | $14 | $34 | 0.53× | $48 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 7 | $68 | $68 | $20 | $48 | 0.60× | $68 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 7 | $81 | $81 | $24 | $57 | 0.50× | $81 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 7 | $104 | $104 | $31 | $73 | 0.48× | $104 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 7 | $121 | $121 | $36 | $85 | 0.45× | $121 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 7 | $3,361 | $3,361 | $508 | $1,607 | 1.8× | $3,361 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 7 | $3,933 | $3,933 | $516 | $1,633 | 1.7× | $3,933 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | $494 | $494 | $148 | $346 | 0.41× | $494 |
| Colonoscopy diagnostic | CPT | 45378 | 7 | $4,429 | $4,429 | $516 | $1,633 | 1.9× | $4,429 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | $5,313 | $5,313 | $516 | $1,633 | 1.3× | $5,313 |
| Colonoscopy with polyp removal | CPT | 45385 | 7 | $5,003 | $5,003 | $674 | $2,134 | 1.8× | $5,003 |
| surgery |
| Major joint replacement w/o MCC | MS-DRG | 470 | 7 | $29 | $29 | $9 | $28.5 | 0.00× | $6,241 |
| OR procedure for obesity w CC | MS-DRG | 620 | 7 | $29 | $29 | $9 | $28.5 | 0.00× | $6,241 |