| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,163.05 |
$3,323 |
1.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,163.05 |
$3,323 |
1.3× |
| Diagnostic colonoscopy (45378) |
$1,130.85 |
$3,231 |
1.2× |
| Colonoscopy with biopsy (45380) |
$1,462.65 |
$4,179 |
1.3× |
| Colonoscopy with lesion removal (45385) |
$1,462.65 |
$4,179 |
1.3× |
| CT head/brain without contrast (70450) |
$798.70 |
$2,282 |
7.8× |
| MRI brain without contrast (70551) |
$1,971.90 |
$5,634 |
8.5× |
| MRI brain with contrast (70552) |
$2,060.45 |
$5,887 |
6.1× |
| MRI brain without and with contrast (70553) |
$2,297.75 |
$6,565 |
6.8× |
| X-ray lower spine, 4+ views (72110) |
$484.05 |
$1,383 |
4.7× |
| MRI lumbar spine without contrast (72148) |
$2,016.70 |
$5,762 |
8.7× |
| CT pelvis with contrast (72193) |
$1,486.45 |
$4,247 |
8.7× |
| MRI lower-extremity joint without contrast (73721) |
$1,739.15 |
$4,969 |
7.5× |
| CT abdomen and pelvis with contrast (74177) |
$1,542.10 |
$4,406 |
4.5× |
| Ultrasound, abdomen complete (76700) |
$893.20 |
$2,552 |
8.8× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$404.25 |
$1,155 |
4.0× |
| Ultrasound, transvaginal (76830) |
$474.60 |
$1,356 |
4.7× |
| Mammography, one breast (diagnostic) (77065) |
$228.55 |
$653 |
2.7× |
| Mammography, both breasts (diagnostic) (77066) |
$287 |
$820 |
2.6× |
| Mammography, screening (bilateral) (77067) |
$221.90 |
$634 |
2.4× |
| Basic metabolic panel (80048) |
$127.05 |
$363 |
15.0× |
| Comprehensive metabolic panel (80053) |
$170.45 |
$487 |
16.1× |
| Lipid panel (80061) |
$76.65 |
$219 |
5.7× |
| Renal function panel (80069) |
$90.30 |
$258 |
10.4× |
| Hepatic function panel (80076) |
$172.20 |
$492 |
21.1× |
| Urinalysis, non-automated, without microscopy (81002) |
$12.25 |
$35 |
3.5× |
| PSA, total (84153) |
$72.45 |
$207 |
3.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$97.65 |
$279 |
5.8× |
| CBC with automated differential (85025) |
$51.10 |
$146 |
6.6× |
| CBC, automated (85027) |
$51.10 |
$146 |
7.9× |
| Prothrombin time (PT) (85610) |
$25.90 |
$74 |
6.0× |
| Partial thromboplastin time (PTT) (85730) |
$42.35 |
$121 |
7.0× |
| Sleep study (attended polysomnography) (95810) |
$1,531.60 |
$4,376 |
1.8× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$102.90 |
$294 |
3.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$122.50 |
$350 |
0.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$157.50 |
$450 |
1.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$204.75 |
$585 |
1.6× |