| Breast lesion removal (open) (19120) |
$235.44 |
$654 |
0.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$731.88 |
$2,033 |
0.9× |
| CT head/brain without contrast (70450) |
$225.36 |
$626 |
2.4× |
| MRI brain without contrast (70551) |
$738.36 |
$2,051 |
3.5× |
| MRI brain with contrast (70552) |
$1,326.78 |
$3,685.50 |
4.2× |
| MRI brain without and with contrast (70553) |
$1,343.52 |
$3,732 |
4.3× |
| X-ray lower spine, 4+ views (72110) |
$38.34 |
$106.50 |
0.4× |
| MRI lumbar spine without contrast (72148) |
$738.36 |
$2,051 |
3.5× |
| CT pelvis with contrast (72193) |
$311.40 |
$865 |
2.0× |
| MRI lower-extremity joint without contrast (73721) |
$738.36 |
$2,051 |
3.5× |
| CT abdomen and pelvis with contrast (74177) |
$471.60 |
$1,310 |
1.5× |
| Ultrasound, abdomen complete (76700) |
$84.96 |
$236 |
0.9× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$81 |
$225 |
0.9× |
| Ultrasound, transvaginal (76830) |
$70.20 |
$195 |
0.7× |
| Mammography, one breast (diagnostic) (77065) |
$77.76 |
$216 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$155.52 |
$432 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$85.68 |
$238 |
0.9× |
| Basic metabolic panel (80048) |
$17.24 |
$47.88 |
2.0× |
| Comprehensive metabolic panel (80053) |
$34.02 |
$94.50 |
3.2× |
| Lipid panel (80061) |
$8.28 |
$23 |
0.6× |
| Renal function panel (80069) |
$15.12 |
$42 |
1.7× |
| Hepatic function panel (80076) |
$22.50 |
$62.50 |
2.8× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.68 |
$13 |
1.3× |
| PSA, total (84153) |
$26.46 |
$73.50 |
1.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$11.16 |
$31 |
0.7× |
| CBC with automated differential (85025) |
$18 |
$50 |
2.3× |
| CBC, automated (85027) |
$12.60 |
$35 |
1.9× |
| Prothrombin time (PT) (85610) |
$14.40 |
$40 |
3.4× |
| Partial thromboplastin time (PTT) (85730) |
$14.49 |
$40.25 |
2.4× |
| Electrocardiogram (ECG), complete (93000) |
$19.08 |
$53 |
0.4× |
| Left heart catheterization (93452) |
$2,944.80 |
$8,180 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$772.56 |
$2,146 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$28.08 |
$78 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$77.22 |
$214.50 |
0.6× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$70.20 |
$195 |
0.6× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$116.10 |
$322.50 |
1.0× |
| Office consultation (low complexity, ~30 min) (99243) |
$54.54 |
$151.50 |
0.5× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$70.38 |
$195.50 |
0.6× |
| Preventive visit, new patient (age 18–39) (99385) |
$67.68 |
$188 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$62.28 |
$173 |
— |