| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,677.20 |
$4,193 |
1.8× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,813.20 |
$4,533 |
1.9× |
| Diagnostic colonoscopy (45378) |
$2,280.40 |
$5,701 |
2.3× |
| Colonoscopy with biopsy (45380) |
$2,269.20 |
$5,673 |
1.8× |
| Colonoscopy with lesion removal (45385) |
$1,882.80 |
$4,707 |
1.5× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$952 |
$2,380 |
1.0× |
| CT head/brain without contrast (70450) |
$1,227.20 |
$3,068 |
11.2× |
| MRI brain without contrast (70551) |
$1,731.60 |
$4,329 |
6.9× |
| MRI brain with contrast (70552) |
$1,771.20 |
$4,428 |
4.9× |
| MRI brain without and with contrast (70553) |
$1,767.20 |
$4,418 |
4.9× |
| X-ray lower spine, 4+ views (72110) |
$447.20 |
$1,118 |
4.1× |
| MRI lumbar spine without contrast (72148) |
$1,576.80 |
$3,942 |
6.3× |
| CT pelvis with contrast (72193) |
$1,860.80 |
$4,652 |
10.2× |
| MRI lower-extremity joint without contrast (73721) |
$1,554.40 |
$3,886 |
6.2× |
| CT abdomen and pelvis with contrast (74177) |
$3,589.60 |
$8,974 |
9.9× |
| Ultrasound, abdomen complete (76700) |
$838.80 |
$2,097 |
7.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$548 |
$1,370 |
5.0× |
| Ultrasound, transvaginal (76830) |
$667.60 |
$1,669 |
6.1× |
| Mammography, one breast (diagnostic) (77065) |
$258 |
$645 |
3.0× |
| Mammography, both breasts (diagnostic) (77066) |
$515.60 |
$1,289 |
4.7× |
| Mammography, screening (bilateral) (77067) |
$152.80 |
$382 |
1.7× |
| Basic metabolic panel (80048) |
$72 |
$180 |
8.5× |
| Comprehensive metabolic panel (80053) |
$56.80 |
$142 |
5.4× |
| Lipid panel (80061) |
$24.66 |
$61.64 |
1.8× |
| Renal function panel (80069) |
$38 |
$95 |
4.4× |
| Hepatic function panel (80076) |
$68.80 |
$172 |
8.4× |
| Urinalysis, non-automated, without microscopy (81002) |
$23.60 |
$59 |
6.8× |
| PSA, total (84153) |
$4 |
$10 |
0.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$23.40 |
$58.50 |
1.4× |
| CBC with automated differential (85025) |
$54 |
$135 |
6.9× |
| CBC, automated (85027) |
$36.40 |
$91 |
5.6× |
| Prothrombin time (PT) (85610) |
$37.20 |
$93 |
8.7× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$15 |
1.0× |
| Left heart catheterization (93452) |
$2,429.60 |
$6,074 |
0.7× |
| Sleep study (attended polysomnography) (95810) |
$2,321.20 |
$5,803 |
2.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$90.80 |
$227 |
3.1× |