| emergency |
| ED visit level 1 | CPT | 99281 | 68 | $744 | $74.4 | $230.64 | $520.8 | $632.4 |
| ED visit level 2 | CPT | 99282 | 81 | $878 | $87.8 | $272.18 | $614.6 | $746.3 |
| ED visit level 3 | CPT | 99283 | 81 | $2,180 | $218 | $675.8 | $1,526 | $1,853 |
| ED visit level 4 | CPT | 99284 | 84 | $3,044 | $304.4 | $284.92 | $2,130.8 | $2,587.4 |
| ED visit level 5 | CPT | 99285 | 84 | $3,651 | $365.1 | $341.73 | $2,555.7 | $3,103.35 |
| Critical care, first hour | CPT | 99291 | 68 | $4,913 | $491.3 | $1,523.03 | $3,439.1 | $4,176.05 |
| imaging |
| CT head without contrast | CPT | 70450 | 77 | $2,420 | $242 | $750.2 | $1,694 | $2,057 |
| CT head with contrast | CPT | 70460 | 77 | $1,910 | $191 | $592.1 | $1,337 | $1,623.5 |
| CT head with and without contrast | CPT | 70470 | 77 | $2,922 | $292.2 | $905.82 | $2,045.4 | $2,483.7 |
| CT neck with contrast | CPT | 70491 | 77 | $1,887 | $188.7 | $584.97 | $1,320.9 | $1,603.95 |
| MRI brain without contrast | CPT | 70551 | 77 | $6,344 | $634.4 | $1,966.64 | $4,440.8 | $5,392.4 |
| MRI brain with contrast | CPT | 70552 | 77 | $7,296 | $729.6 | $2,261.76 | $5,107.2 | $6,201.6 |
| MRI brain with and without contrast | CPT | 70553 | 77 | $8,392 | $839.2 | $2,601.52 | $5,874.4 | $7,133.2 |
| Chest X-ray single view | CPT | 71045 | 81 | $598 | $59.8 | $185.38 | $418.6 | $508.3 |
| Chest X-ray 2 views | CPT | 71046 | 81 | $659 | $65.9 | $204.29 | $461.3 | $560.15 |
| Chest X-ray 3 views | CPT | 71047 | 81 | $915 | $91.5 | $283.65 | $640.5 | $777.75 |
| CT chest without contrast | CPT | 71250 | 77 | $5,432 | $543.2 | $1,683.92 | $3,802.4 | $4,617.2 |
| CT chest with contrast | CPT | 71260 | 77 | $6,213 | $621.3 | $1,926.03 | $4,349.1 | $5,281.05 |
| CT chest with and without contrast | CPT | 71270 | 77 | $5,003 | $500.3 | $1,550.93 | $3,502.1 | $4,252.55 |
| MRI chest without contrast | CPT | 71550 | 77 | $7,665 | $766.5 | $2,376.15 | $5,365.5 | $6,515.25 |
| MRI chest with and without contrast | CPT | 71552 | 77 | $7,195 | $719.5 | $2,230.45 | $5,036.5 | $6,115.75 |
| Lumbosacral spine X-ray | CPT | 72100 | 81 | $1,337 | $133.7 | $414.47 | $935.9 | $1,136.45 |
| CT cervical spine without contrast | CPT | 72125 | 77 | $3,402 | $340.2 | $1,054.62 | $2,381.4 | $2,891.7 |
| CT thoracic spine without contrast | CPT | 72128 | 77 | $4,023 | $402.3 | $1,247.13 | $2,816.1 | $3,419.55 |
| CT lumbar spine without contrast | CPT | 72131 | 77 | $4,314 | $431.4 | $1,337.34 | $3,019.8 | $3,666.9 |
| MRI cervical spine without contrast | CPT | 72141 | 77 | $6,938 | $693.8 | $2,150.78 | $4,856.6 | $5,897.3 |
| MRI thoracic spine without contrast | CPT | 72146 | 77 | $7,665 | $766.5 | $2,376.15 | $5,365.5 | $6,515.25 |
| MRI lumbar spine without contrast | CPT | 72148 | 77 | $7,665 | $766.5 | $2,376.15 | $5,365.5 | $6,515.25 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 77 | $8,814 | $881.4 | $2,732.34 | $6,169.8 | $7,491.9 |
| MRI cervical spine with and without contrast | CPT | 72156 | 77 | $8,090 | $809 | $2,507.9 | $5,663 | $6,876.5 |
| MRI lumbar spine with contrast | CPT | 72158 | 77 | $8,938 | $893.8 | $2,770.78 | $6,256.6 | $7,597.3 |
| CT pelvis without contrast | CPT | 72192 | 77 | $1,630 | $163 | $505.3 | $1,141 | $1,385.5 |
| CT pelvis with contrast | CPT | 72193 | 77 | $1,893 | $189.3 | $586.83 | $1,325.1 | $1,609.05 |
| Shoulder X-ray | CPT | 73030 | 81 | $1,309.5 | $130.95 | $270.63 | $624.64 | $1,113.08 |
| Humerus X-ray | CPT | 73060 | 81 | $1,407 | $140.7 | $290.78 | $671.14 | $1,195.95 |
| Hand X-ray 3 views | CPT | 73130 | 81 | $1,317 | $131.7 | $272.18 | $628.21 | $1,119.45 |
| MRI upper extremity joint without contrast | CPT | 73221 | 77 | $9,939 | $993.9 | $2,054.06 | $4,638.2 | $8,448.15 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 77 | $11,391 | $1,139.1 | $3,531.21 | $7,973.7 | $9,682.35 |
| Knee X-ray 1-2 views | CPT | 73560 | 81 | $1,558.5 | $155.85 | $322.09 | $743.41 | $1,324.73 |
| Ankle X-ray 3 views | CPT | 73610 | 81 | $1,518 | $151.8 | $313.72 | $724.09 | $1,290.3 |
| MRI lower extremity joint without contrast | CPT | 73721 | 77 | $9,939 | $993.9 | $2,054.06 | $4,638.2 | $8,448.15 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 77 | $8,763 | $876.3 | $2,716.53 | $6,134.1 | $7,448.55 |
| CT abdomen without contrast | CPT | 74150 | 77 | $3,880 | $388 | $1,202.8 | $2,716 | $3,298 |
| CT abdomen with contrast | CPT | 74160 | 77 | $7,127 | $712.7 | $2,209.37 | $4,988.9 | $6,057.95 |
| CT abdomen with and without contrast | CPT | 74170 | 77 | $10,656 | $1,065.6 | $3,303.36 | $7,459.2 | $9,057.6 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 77 | $5,643 | $564.3 | $1,749.33 | $3,950.1 | $4,796.55 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 77 | $8,934 | $893.4 | $2,769.54 | $6,253.8 | $7,593.9 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 77 | $12,660 | $1,266 | $3,924.6 | $8,862 | $10,761 |
| MRI abdomen without contrast | CPT | 74181 | 77 | $3,690 | $369 | $1,143.9 | $2,583 | $3,136.5 |
| MRI abdomen with and without contrast | CPT | 74183 | 77 | $8,311 | $831.1 | $2,576.41 | $5,817.7 | $7,064.35 |
| Abdominal ultrasound complete | CPT | 76700 | 77 | $2,736 | $273.6 | $848.16 | $1,915.2 | $2,325.6 |
| Abdominal ultrasound limited | CPT | 76705 | 77 | $2,585 | $258.5 | $801.35 | $1,809.5 | $2,197.25 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 77 | $2,863 | $286.3 | $887.53 | $2,004.1 | $2,433.55 |
| Obstetric ultrasound first trimester | CPT | 76801 | 81 | $2,357 | $235.7 | $730.67 | $1,649.9 | $2,003.45 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 81 | $1,327 | $132.7 | $411.37 | $928.9 | $1,127.95 |
| Transvaginal ultrasound | CPT | 76830 | 81 | $2,243 | $224.3 | $695.33 | $1,570.1 | $1,906.55 |
| Pelvic ultrasound complete | CPT | 76856 | 77 | $3,305 | $330.5 | $1,024.55 | $2,313.5 | $2,809.25 |
| Scrotal ultrasound | CPT | 76870 | 77 | $3,061 | $306.1 | $948.91 | $2,142.7 | $2,601.85 |
| Diagnostic mammography unilateral | CPT | 77065 | 84 | $980 | $98 | $91.73 | $686 | $833 |
| Diagnostic mammography bilateral | CPT | 77066 | 84 | $1,298 | $129.8 | $121.49 | $908.6 | $1,103.3 |
| Screening mammography bilateral | CPT | 77067 | 84 | $872 | $87.2 | $81.62 | $610.4 | $741.2 |
| EKG tracing only | CPT | 93005 | 84 | $567 | $56.7 | $53.07 | $396.9 | $481.95 |
| EKG interpretation only | CPT | 93010 | 51 | $34 | $3.4 | $9.73 | $23.8 | $28.9 |
| Transthoracic echocardiogram complete | CPT | 93306 | 84 | $1,734 | $173.4 | $29.2 | $265.2 | $1,473.9 |
| Transthoracic echocardiogram | CPT | 93307 | 68 | $763 | $76.3 | $236.53 | $534.1 | $648.55 |
| Stress echocardiogram | CPT | 93350 | 68 | $206 | $20.6 | $63.86 | $144.2 | $175.1 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 81 | $185 | $18.5 | $57.35 | $129.5 | $157.25 |
| General health panel | CPT | 80050 | 84 | $671 | $67.1 | $62.81 | $469.7 | $570.35 |
| Electrolyte panel | CPT | 80051 | 81 | $271 | $27.1 | $84.01 | $189.7 | $230.35 |
| Comprehensive metabolic panel | CPT | 80053 | 81 | $277 | $27.7 | $85.87 | $193.9 | $235.45 |
| Lipid panel | CPT | 80061 | 81 | $156 | $15.6 | $48.36 | $109.2 | $132.6 |
| Renal function panel | CPT | 80069 | 81 | $297 | $29.7 | $92.07 | $207.9 | $252.45 |
| Hepatic function panel | CPT | 80076 | 81 | $185 | $18.5 | $57.35 | $129.5 | $157.25 |
| Urinalysis non-automated | CPT | 81002 | 68 | $72 | $7.2 | $22.32 | $50.4 | $61.2 |
| Urinalysis automated | CPT | 81003 | 81 | $32 | $3.2 | $9.92 | $22.4 | $27.2 |
| Glucose quantitative | CPT | 82947 | 81 | $50 | $5 | $15.5 | $35 | $42.5 |
| Hemoglobin A1c | CPT | 83036 | 81 | $71 | $7.1 | $22.01 | $49.7 | $60.35 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 81 | $352 | $35.2 | $109.12 | $246.4 | $299.2 |
| Complete blood count with automated differential | CPT | 85025 | 81 | $134 | $13.4 | $41.54 | $93.8 | $113.9 |
| Complete blood count without differential | CPT | 85027 | 81 | $89 | $8.9 | $27.59 | $62.3 | $75.65 |
| Urine culture bacterial | CPT | 87086 | 79 | $135 | $13.5 | $41.85 | $94.5 | $114.75 |
| Tissue exam by pathologist level IV | CPT | 88305 | 84 | $1,128 | $112.8 | $105.58 | $789.6 | $958.8 |
| maternity |
| Fetal non-stress test | CPT | 59025 | 84 | $724 | $72.4 | $67.77 | $506.8 | $615.4 |
| office |
| Office visit, established patient, 5 min | CPT | 99211 | 82 | $435 | $43.5 | $40.72 | $304.5 | $369.75 |
| preventive |
| Upper GI endoscopy diagnostic | CPT | 43235 | 80 | $2,763 | $276.3 | $822.79 | $1,934.1 | $2,348.55 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 80 | $5,199 | $519.9 | $1,548.2 | $3,639.3 | $4,419.15 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 80 | $3,768 | $376.8 | $1,122.07 | $2,637.6 | $3,202.8 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 80 | $3,768 | $376.8 | $1,122.07 | $2,637.6 | $3,202.8 |
| Colonoscopy diagnostic | CPT | 45378 | 80 | $6,198 | $619.8 | $1,845.69 | $4,338.6 | $5,268.3 |
| Colonoscopy with biopsy | CPT | 45380 | 80 | $6,816 | $681.6 | $2,029.72 | $4,771.2 | $5,793.6 |
| Colonoscopy with polyp removal | CPT | 45385 | 80 | $7,565 | $756.5 | $2,252.77 | $5,295.5 | $6,430.25 |
| surgery |
| PCI single major coronary artery | CPT | 92920 | 83 | $11,569 | $1,156.9 | $1,082.86 | $8,098.3 | $9,833.65 |
| PCI with drug-eluting stent | CPT | 92928 | 67 | $25,102 | $2,510.2 | $8,366.5 | $17,571 | $21,337 |
| PCI bypass graft | CPT | 92937 | 67 | $17,571 | $1,757.1 | $5,856.41 | $12,300 | $14,935 |
| Coronary angiography with cath | CPT | 93455 | 83 | $4,268 | $426.8 | $399.48 | $2,987.6 | $3,627.8 |
| Coronary angiography with bypass cath | CPT | 93458 | 83 | $10,669 | $1,066.9 | $998.62 | $7,468.3 | $9,068.65 |