| emergency |
| ED visit level 1 | CPT | 99281 | 4 | $89 | $89 | $17 | $61.5 | 0.44× | $71 |
| ED visit level 2 | CPT | 99282 | 4 | $146 | $146 | $28 | $101 | 0.43× | $117 |
| ED visit level 3 | CPT | 99283 | 4 | $243 | $243 | $46 | $167.5 | 0.41× | $194 |
| ED visit level 4 | CPT | 99284 | 4 | $426 | $426 | $81 | $294 | 0.44× | $341 |
| ED visit level 5 | CPT | 99285 | 4 | $677 | $677 | $128 | $467.5 | 0.45× | $542 |
| Critical care, first hour | CPT | 99291 | 4 | $1,263 | $1,263 | $79 | $321.5 | 0.30× | $1,010 |
| imaging |
| Chest X-ray single view | CPT | 71045 | 4 | $144 | $144 | $27 | $99.5 | 1.1× | $115 |
| Chest X-ray 2 views | CPT | 71046 | 4 | $181 | $181 | $34 | $125 | 1.3× | $145 |
| Chest X-ray 3 views | CPT | 71047 | 4 | $212 | $212 | $40 | $146.5 | 1.5× | $170 |
| Lumbosacral spine X-ray | CPT | 72100 | 4 | $212 | $212 | $40 | $146.5 | 1.4× | $170 |
| Shoulder X-ray | CPT | 73030 | 4 | $185 | $185 | $35 | $128 | 1.4× | $148 |
| Humerus X-ray | CPT | 73060 | 4 | $159 | $159 | $30 | $109.5 | 1.2× | $127 |
| Hand X-ray 3 views | CPT | 73130 | 4 | $159 | $159 | $30 | $109.5 | 1.2× | $127 |
| Knee X-ray 1-2 views | CPT | 73560 | 4 | $159 | $159 | $30 | $109.5 | 1.2× | $127 |
| Ankle X-ray 3 views | CPT | 73610 | 4 | $159 | $159 | $30 | $109.5 | 1.2× | $127 |
| Abdominal ultrasound complete | CPT | 76700 | 4 | $586 | $586 | $66 | $271.5 | 1.8× | $469 |
| Abdominal ultrasound limited | CPT | 76705 | 4 | $382 | $382 | $72 | $264 | 1.8× | $306 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 4 | $382 | $382 | $72 | $264 | 1.8× | $306 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 4 | $483 | $483 | $92 | $333 | 2.2× | $386 |
| Transvaginal ultrasound | CPT | 76830 | 4 | $700 | $700 | $133 | $483 | 3.3× | $560 |
| Pelvic ultrasound complete | CPT | 76856 | 4 | $458 | $458 | $87 | $316.5 | 2.2× | $366 |
| Scrotal ultrasound | CPT | 76870 | 4 | $268 | $268 | $38 | $155 | 1.2× | $214 |
| EKG tracing only | CPT | 93005 | 4 | $149 | $149 | $17 | $70.5 | 0.60× | $119 |
| Transthoracic echocardiogram complete | CPT | 93306 | 4 | $1,280 | $1,280 | $71 | $290 | 0.48× | $1,024 |
| Transthoracic echocardiogram | CPT | 93307 | 4 | $188 | $188 | $36 | $129.5 | 0.52× | $150 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 4 | $228 | $228 | $43 | $157.5 | 4.9× | $182 |
| General health panel | CPT | 80050 | 4 | $500 | $500 | $95 | $345 | 3.2× | $400 |
| Electrolyte panel | CPT | 80051 | 4 | $137 | $137 | $26 | $94.5 | 4.0× | $110 |
| Comprehensive metabolic panel | CPT | 80053 | 4 | $342 | $342 | $49 | $200.5 | 4.5× | $274 |
| Lipid panel | CPT | 80061 | 4 | $198 | $198 | $17 | $67.5 | 1.8× | $158 |
| Renal function panel | CPT | 80069 | 4 | $165 | $165 | $31 | $114 | 4.2× | $132 |
| Urinalysis automated | CPT | 81003 | 4 | $31 | $31 | $6 | $21.5 | 1.5× | $25 |
| Glucose quantitative | CPT | 82947 | 4 | $65 | $65 | $3 | $23 | 1.3× | $52 |
| Hemoglobin A1c | CPT | 83036 | 4 | $96 | $96 | $18 | $66 | 2.5× | $77 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 4 | $127 | $127 | $24 | $87.5 | 1.9× | $102 |
| Complete blood count with automated differential | CPT | 85025 | 4 | $68 | $68 | $13 | $47 | 1.8× | $54 |
| Urine culture identification | CPT | 87088 | 4 | $30 | $30 | $6 | $21 | 0.94× | $24 |