| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,058.50 |
$2,117 |
1.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,575.50 |
$3,151 |
1.7× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$979.50 |
$1,959 |
1.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$588.50 |
$1,177 |
0.6× |
| CT head/brain without contrast (70450) |
$934 |
$1,868 |
8.6× |
| MRI brain without contrast (70551) |
$1,512.50 |
$3,025 |
6.1× |
| MRI brain with contrast (70552) |
$1,764.50 |
$3,529 |
4.9× |
| MRI brain without and with contrast (70553) |
$1,939 |
$3,878 |
5.4× |
| X-ray lower spine, 4+ views (72110) |
$423.50 |
$847 |
3.9× |
| MRI lumbar spine without contrast (72148) |
$1,583 |
$3,166 |
6.4× |
| CT pelvis with contrast (72193) |
$1,285 |
$2,570 |
7.1× |
| MRI lower-extremity joint without contrast (73721) |
$1,583 |
$3,166 |
6.4× |
| CT abdomen and pelvis with contrast (74177) |
$2,383.50 |
$4,767 |
6.6× |
| Ultrasound, abdomen complete (76700) |
$262 |
$524 |
2.4× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$510.25 |
$1,020.50 |
4.7× |
| Ultrasound, transvaginal (76830) |
$467.50 |
$935 |
4.3× |
| Mammography, one breast (diagnostic) (77065) |
$179.50 |
$359 |
2.1× |
| Mammography, both breasts (diagnostic) (77066) |
$214 |
$428 |
1.9× |
| Mammography, screening (bilateral) (77067) |
$191.50 |
$383 |
2.1× |
| Basic metabolic panel (80048) |
$189 |
$378 |
22.3× |
| Comprehensive metabolic panel (80053) |
$235 |
$470 |
22.3× |
| Obstetric panel (80055) |
$307 |
$614 |
6.4× |
| Lipid panel (80061) |
$75.75 |
$151.50 |
5.7× |
| Renal function panel (80069) |
$183 |
$366 |
21.1× |
| Hepatic function panel (80076) |
$153.50 |
$307 |
18.8× |
| Urinalysis, non-automated, without microscopy (81002) |
$15.50 |
$31 |
4.5× |
| PSA, total (84153) |
$107 |
$214 |
5.8× |
| Thyroid stimulating hormone (TSH) (84443) |
$129.50 |
$259 |
7.7× |
| CBC with automated differential (85025) |
$105.50 |
$211 |
13.6× |
| CBC, automated (85027) |
$81 |
$162 |
12.5× |
| Prothrombin time (PT) (85610) |
$64.75 |
$129.50 |
15.1× |
| Partial thromboplastin time (PTT) (85730) |
$77 |
$154 |
12.8× |
| Left heart catheterization (93452) |
$7,862 |
$15,724 |
2.3× |
| Sleep study (attended polysomnography) (95810) |
$2,276.50 |
$4,553 |
2.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$58.50 |
$117 |
2.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$203 |
$406 |
1.5× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$308 |
$616 |
2.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$388.50 |
$777 |
2.8× |