| Shoulder arthroscopy with decompression (29826) |
$1,894.80 |
$3,158 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,960.80 |
$3,268 |
0.6× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$640.80 |
$1,068 |
0.8× |
| CT head/brain without contrast (70450) |
$1,692.60 |
$2,821 |
17.3× |
| MRI brain without contrast (70551) |
$3,763.20 |
$6,272 |
16.8× |
| MRI brain with contrast (70552) |
$4,239 |
$7,065 |
12.9× |
| MRI brain without and with contrast (70553) |
$5,409 |
$9,015 |
16.5× |
| X-ray lower spine, 4+ views (72110) |
$574.20 |
$957 |
5.9× |
| MRI lumbar spine without contrast (72148) |
$3,509.40 |
$5,849 |
15.7× |
| CT pelvis with contrast (72193) |
$2,767.80 |
$4,613 |
16.8× |
| MRI lower-extremity joint without contrast (73721) |
$3,517.20 |
$5,862 |
15.7× |
| CT abdomen and pelvis with contrast (74177) |
$4,987.20 |
$8,312 |
15.2× |
| Ultrasound, abdomen complete (76700) |
$1,012.20 |
$1,687 |
10.3× |
| Ultrasound, transvaginal (76830) |
$962.40 |
$1,604 |
9.8× |
| Mammography, one breast (diagnostic) (77065) |
$289.20 |
$482 |
3.4× |
| Mammography, both breasts (diagnostic) (77066) |
$578.40 |
$964 |
5.2× |
| Mammography, screening (bilateral) (77067) |
$238.80 |
$398 |
2.6× |
| Basic metabolic panel (80048) |
$144 |
$240 |
17.0× |
| Comprehensive metabolic panel (80053) |
$148.80 |
$248 |
14.1× |
| Obstetric panel (80055) |
$205.80 |
$343 |
4.3× |
| Lipid panel (80061) |
$210.60 |
$351 |
15.7× |
| Renal function panel (80069) |
$202.80 |
$338 |
23.4× |
| Hepatic function panel (80076) |
$178.80 |
$298 |
21.9× |
| Urinalysis, non-automated, with microscopy (81000) |
$52.80 |
$88 |
13.1× |
| Urinalysis, non-automated, without microscopy (81002) |
$24.30 |
$40.50 |
7.0× |
| PSA, total (84153) |
$184.20 |
$307 |
10.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$159 |
$265 |
9.5× |
| CBC with automated differential (85025) |
$72 |
$120 |
9.3× |
| CBC, automated (85027) |
$55.20 |
$92 |
8.5× |
| Prothrombin time (PT) (85610) |
$63.30 |
$105.50 |
14.8× |
| Partial thromboplastin time (PTT) (85730) |
$256.80 |
$428 |
42.7× |
| Electrocardiogram (ECG), complete (93000) |
$136.80 |
$228 |
2.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$189 |
$315 |
6.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$178.80 |
$298 |
1.4× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$295.20 |
$492 |
2.4× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$872.40 |
$1,454 |
7.0× |
| Office consultation (low complexity, ~30 min) (99243) |
$75 |
$125 |
0.6× |
| Preventive visit, new patient (age 18–39) (99385) |
$115.80 |
$193 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$139.80 |
$233 |
— |