| Upper GI endoscopy (EGD), diagnostic (43235) |
$190.60 |
$953 |
0.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$166.40 |
$832 |
0.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$422 |
$2,110 |
0.5× |
| CT head/brain without contrast (70450) |
$613.20 |
$3,066 |
6.3× |
| MRI brain without contrast (70551) |
$540.10 |
$2,700.50 |
2.4× |
| MRI brain with contrast (70552) |
$817 |
$4,085 |
2.5× |
| MRI brain without and with contrast (70553) |
$1,207.60 |
$6,038 |
3.7× |
| X-ray lower spine, 4+ views (72110) |
$138.60 |
$693 |
1.4× |
| MRI lumbar spine without contrast (72148) |
$540.10 |
$2,700.50 |
2.4× |
| CT pelvis with contrast (72193) |
$718 |
$3,590 |
4.4× |
| MRI lower-extremity joint without contrast (73721) |
$748.80 |
$3,744 |
3.4× |
| CT abdomen and pelvis with contrast (74177) |
$1,795 |
$8,975 |
5.6× |
| Ultrasound, abdomen complete (76700) |
$304.60 |
$1,523 |
3.1× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$317.60 |
$1,588 |
3.3× |
| Ultrasound, transvaginal (76830) |
$206.20 |
$1,031 |
2.1× |
| Mammography, one breast (diagnostic) (77065) |
$90.30 |
$451.50 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$113.10 |
$565.50 |
1.0× |
| Mammography, screening (bilateral) (77067) |
$116.60 |
$583 |
1.3× |
| Basic metabolic panel (80048) |
$130.20 |
$651 |
15.4× |
| Comprehensive metabolic panel (80053) |
$173 |
$865 |
16.4× |
| Lipid panel (80061) |
$66.80 |
$334 |
5.0× |
| Renal function panel (80069) |
$108.80 |
$544 |
12.5× |
| Hepatic function panel (80076) |
$151 |
$755 |
18.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$12.40 |
$62 |
3.6× |
| PSA, total (84153) |
$109.40 |
$547 |
5.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$25.20 |
$126 |
1.5× |
| CBC with automated differential (85025) |
$34.20 |
$171 |
4.4× |
| CBC, automated (85027) |
$29.40 |
$147 |
4.5× |
| Prothrombin time (PT) (85610) |
$41.60 |
$208 |
9.7× |
| Partial thromboplastin time (PTT) (85730) |
$33 |
$165 |
5.5× |
| Left heart catheterization (93452) |
$2,619.20 |
$13,096 |
0.9× |
| Sleep study (attended polysomnography) (95810) |
$1,270.80 |
$6,354 |
1.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$43 |
$215 |
1.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$80.70 |
$403.50 |
0.7× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$97.60 |
$488 |
0.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$116.90 |
$584.50 |
0.9× |