| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,597 |
$1,597 |
1.5× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,057.27 |
$1,057.27 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,808.40 |
$1,808.40 |
1.7× |
| CT head/brain without contrast (70450) |
$1,043 |
$1,043 |
8.3× |
| MRI brain without contrast (70551) |
$1,886.70 |
$1,886.70 |
6.6× |
| MRI brain with contrast (70552) |
$2,838 |
$2,838 |
6.8× |
| MRI brain without and with contrast (70553) |
$3,834 |
$3,834 |
9.2× |
| X-ray lower spine, 4+ views (72110) |
$673 |
$673 |
5.4× |
| MRI lumbar spine without contrast (72148) |
$1,961 |
$1,961 |
6.9× |
| CT pelvis with contrast (72193) |
$1,549 |
$1,549 |
7.4× |
| MRI lower-extremity joint without contrast (73721) |
$2,193.50 |
$2,193.50 |
7.7× |
| CT abdomen and pelvis with contrast (74177) |
$3,095 |
$3,095 |
7.4× |
| Ultrasound, abdomen complete (76700) |
$1,001 |
$1,001 |
8.0× |
| Ultrasound, transvaginal (76830) |
$932 |
$932 |
7.4× |
| Mammography, one breast (diagnostic) (77065) |
$572 |
$572 |
6.6× |
| Mammography, both breasts (diagnostic) (77066) |
$759.15 |
$759.15 |
6.9× |
| Mammography, screening (bilateral) (77067) |
$689.21 |
$689.21 |
7.6× |
| Basic metabolic panel (80048) |
$87 |
$87 |
10.3× |
| Comprehensive metabolic panel (80053) |
$116 |
$116 |
11.0× |
| Lipid panel (80061) |
$64 |
$64 |
4.8× |
| Renal function panel (80069) |
$88 |
$88 |
10.1× |
| Hepatic function panel (80076) |
$94 |
$94 |
11.5× |
| Urinalysis, non-automated, with microscopy (81000) |
$30 |
$30 |
7.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$20 |
$20 |
5.7× |
| PSA, total (84153) |
$113 |
$113 |
6.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$106 |
$106 |
6.3× |
| CBC with automated differential (85025) |
$73 |
$73 |
9.4× |
| CBC, automated (85027) |
$41 |
$41 |
6.3× |
| Prothrombin time (PT) (85610) |
$36 |
$36 |
8.4× |
| Partial thromboplastin time (PTT) (85730) |
$62.50 |
$62.50 |
10.4× |
| Sleep study (attended polysomnography) (95810) |
$2,738 |
$2,738 |
2.7× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$163.54 |
$163.54 |
5.6× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$414 |
$414 |
2.6× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$440 |
$440 |
2.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$608 |
$608 |
3.8× |