| Upper GI endoscopy (EGD) with biopsy (43239) |
$188.10 |
$1,254 |
0.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$124.80 |
$832 |
0.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$316.35 |
$2,109 |
0.4× |
| CT head/brain without contrast (70450) |
$438.15 |
$2,921 |
4.5× |
| MRI brain without contrast (70551) |
$368.85 |
$2,459 |
1.7× |
| MRI brain with contrast (70552) |
$612.75 |
$4,085 |
1.9× |
| MRI brain without and with contrast (70553) |
$905.70 |
$6,038 |
2.8× |
| X-ray lower spine, 4+ views (72110) |
$136.50 |
$910 |
1.4× |
| MRI lumbar spine without contrast (72148) |
$405.08 |
$2,700.50 |
1.8× |
| CT pelvis with contrast (72193) |
$512.70 |
$3,418 |
3.2× |
| MRI lower-extremity joint without contrast (73721) |
$561.60 |
$3,744 |
2.5× |
| CT abdomen and pelvis with contrast (74177) |
$1,346.25 |
$8,975 |
4.2× |
| Ultrasound, abdomen complete (76700) |
$228.45 |
$1,523 |
2.4× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$238.20 |
$1,588 |
2.5× |
| Ultrasound, transvaginal (76830) |
$123.45 |
$823 |
1.3× |
| Mammography, one breast (diagnostic) (77065) |
$93.90 |
$626 |
1.1× |
| Mammography, both breasts (diagnostic) (77066) |
$76.50 |
$510 |
0.7× |
| Mammography, screening (bilateral) (77067) |
$73.05 |
$487 |
0.8× |
| Basic metabolic panel (80048) |
$97.65 |
$651 |
11.5× |
| Comprehensive metabolic panel (80053) |
$129.75 |
$865 |
12.3× |
| Obstetric panel (80055) |
$24.60 |
$164 |
0.5× |
| Lipid panel (80061) |
$50.10 |
$334 |
3.7× |
| Renal function panel (80069) |
$81.60 |
$544 |
9.4× |
| Hepatic function panel (80076) |
$113.25 |
$755 |
13.9× |
| Urinalysis, non-automated, without microscopy (81002) |
$13.50 |
$90 |
3.9× |
| PSA, total (84153) |
$82.05 |
$547 |
4.5× |
| Thyroid stimulating hormone (TSH) (84443) |
$18.98 |
$126.50 |
1.1× |
| CBC with automated differential (85025) |
$25.65 |
$171 |
3.3× |
| CBC, automated (85027) |
$22.05 |
$147 |
3.4× |
| Prothrombin time (PT) (85610) |
$31.20 |
$208 |
7.3× |
| Partial thromboplastin time (PTT) (85730) |
$24.75 |
$165 |
4.1× |
| Left heart catheterization (93452) |
$2,062.35 |
$13,749 |
0.7× |
| Sleep study (attended polysomnography) (95810) |
$953.10 |
$6,354 |
1.2× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$33.68 |
$224.50 |
1.2× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$61.80 |
$412 |
0.5× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$73.20 |
$488 |
0.6× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$84.08 |
$560.50 |
0.7× |