| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,179.90 |
$3,933 |
1.4× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,337.10 |
$4,457 |
1.5× |
| Diagnostic colonoscopy (45378) |
$1,190.40 |
$3,968 |
1.3× |
| Colonoscopy with biopsy (45380) |
$1,309.80 |
$4,366 |
1.1× |
| Colonoscopy with lesion removal (45385) |
$935.70 |
$3,119 |
0.8× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$524.70 |
$1,749 |
0.6× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,240.50 |
$4,135 |
1.5× |
| CT head/brain without contrast (70450) |
$777 |
$2,590 |
7.7× |
| MRI brain without contrast (70551) |
$1,314.30 |
$4,381 |
5.7× |
| MRI brain with contrast (70552) |
$1,340.10 |
$4,467 |
4.0× |
| MRI brain without and with contrast (70553) |
$1,444.20 |
$4,814 |
4.3× |
| X-ray lower spine, 4+ views (72110) |
$371.70 |
$1,239 |
3.7× |
| MRI lumbar spine without contrast (72148) |
$740.40 |
$2,468 |
3.2× |
| CT pelvis with contrast (72193) |
$1,273.80 |
$4,246 |
7.6× |
| MRI lower-extremity joint without contrast (73721) |
$1,125.38 |
$3,751.25 |
4.9× |
| CT abdomen and pelvis with contrast (74177) |
$2,953.50 |
$9,845 |
8.8× |
| Ultrasound, abdomen complete (76700) |
$549.60 |
$1,832 |
5.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$397.50 |
$1,325 |
4.0× |
| Ultrasound, transvaginal (76830) |
$356.10 |
$1,187 |
3.5× |
| Mammography, one breast (diagnostic) (77065) |
$219.90 |
$733 |
2.6× |
| Mammography, both breasts (diagnostic) (77066) |
$293.10 |
$977 |
2.7× |
| Mammography, screening (bilateral) (77067) |
$266.40 |
$888 |
2.9× |
| Basic metabolic panel (80048) |
$68.40 |
$228 |
8.1× |
| Comprehensive metabolic panel (80053) |
$52.80 |
$176 |
5.0× |
| Obstetric panel (80055) |
$199.20 |
$664 |
4.2× |
| Lipid panel (80061) |
$107.10 |
$357 |
8.0× |
| Renal function panel (80069) |
$105.90 |
$353 |
12.2× |
| Hepatic function panel (80076) |
$64.80 |
$216 |
7.9× |
| Urinalysis, non-automated, with microscopy (81000) |
$28.80 |
$96 |
7.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.80 |
$16 |
1.4× |
| PSA, total (84153) |
$71.70 |
$239 |
3.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$172.80 |
$576 |
10.3× |
| CBC with automated differential (85025) |
$71.70 |
$239 |
9.2× |
| CBC, automated (85027) |
$53.40 |
$178 |
8.3× |
| Prothrombin time (PT) (85610) |
$38.10 |
$127 |
8.9× |
| Partial thromboplastin time (PTT) (85730) |
$30.90 |
$103 |
5.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$77.40 |
$258 |
2.7× |