| Breast lesion removal (open) (19120) |
$222.80 |
$557 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$450 |
$1,125 |
0.5× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$450 |
$1,125 |
0.5× |
| Diagnostic colonoscopy (45378) |
$675 |
$1,687.50 |
0.8× |
| Colonoscopy with biopsy (45380) |
$675 |
$1,687.50 |
0.6× |
| Colonoscopy with lesion removal (45385) |
$900 |
$2,250 |
0.8× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$860 |
$2,150 |
1.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$960 |
$2,400 |
1.2× |
| CT head/brain without contrast (70450) |
$652 |
$1,630 |
6.8× |
| MRI brain without contrast (70551) |
$1,002 |
$2,505 |
4.6× |
| MRI brain without and with contrast (70553) |
$1,420 |
$3,550 |
4.4× |
| X-ray lower spine, 4+ views (72110) |
$134.40 |
$336 |
1.4× |
| MRI lumbar spine without contrast (72148) |
$966 |
$2,415 |
4.4× |
| CT pelvis with contrast (72193) |
$792 |
$1,980 |
4.9× |
| MRI lower-extremity joint without contrast (73721) |
$1,008 |
$2,520 |
4.6× |
| CT abdomen and pelvis with contrast (74177) |
$1,452 |
$3,630 |
4.5× |
| Ultrasound, abdomen complete (76700) |
$342 |
$855 |
3.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$280 |
$700 |
2.9× |
| Ultrasound, transvaginal (76830) |
$272 |
$680 |
2.8× |
| Mammography, one breast (diagnostic) (77065) |
$104 |
$260 |
1.2× |
| Mammography, both breasts (diagnostic) (77066) |
$134 |
$335 |
1.2× |
| Mammography, screening (bilateral) (77067) |
$104 |
$260 |
1.1× |
| Basic metabolic panel (80048) |
$140 |
$350 |
16.5× |
| Comprehensive metabolic panel (80053) |
$72 |
$180 |
6.8× |
| Lipid panel (80061) |
$62.40 |
$156 |
4.7× |
| Renal function panel (80069) |
$72 |
$180 |
8.3× |
| Hepatic function panel (80076) |
$92 |
$230 |
11.3× |
| Urinalysis, non-automated, with microscopy (81000) |
$6 |
$15 |
1.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$6 |
$15 |
1.7× |
| PSA, total (84153) |
$64.40 |
$161 |
3.5× |
| Thyroid stimulating hormone (TSH) (84443) |
$54.80 |
$137 |
3.3× |
| CBC with automated differential (85025) |
$44 |
$110 |
5.7× |
| CBC, automated (85027) |
$40 |
$100 |
6.2× |
| Prothrombin time (PT) (85610) |
$25.60 |
$64 |
6.0× |
| Partial thromboplastin time (PTT) (85730) |
$28.80 |
$72 |
4.8× |
| Psychotherapy, 30 minutes (90832) |
$20.40 |
$51 |
0.1× |
| Psychotherapy, 45 minutes (90834) |
$38.80 |
$97 |
0.2× |
| Psychotherapy, 60 minutes (90837) |
$36 |
$90 |
0.2× |
| Sleep study (attended polysomnography) (95810) |
$2,012 |
$5,030 |
2.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$120 |
$300 |
4.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$120 |
$300 |
1.0× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$113.80 |
$284.50 |
0.9× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$121.80 |
$304.50 |
1.0× |