| Upper GI endoscopy (EGD), diagnostic (43235) |
$854 |
$4,945.54 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$854 |
$4,945.54 |
1.0× |
| Diagnostic colonoscopy (45378) |
$876 |
$4,558.55 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,127 |
$6,201.56 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,127 |
$6,201.56 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$5,695 |
$29,669.50 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$833 |
$2,742.88 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$833 |
$3,885.10 |
1.0× |
| Cataract removal with lens insertion (66984) |
$2,174 |
$7,832.69 |
1.0× |
| CT head/brain without contrast (70450) |
$98 |
$4,731.89 |
1.0× |
| MRI brain without contrast (70551) |
$224 |
$5,586.43 |
1.0× |
| MRI brain with contrast (70552) |
$328 |
$5,581.53 |
1.0× |
| MRI brain without and with contrast (70553) |
$328 |
$6,154.90 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$98 |
$1,836.77 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$224 |
$5,342.11 |
1.0× |
| CT pelvis with contrast (72193) |
$165 |
$2,691.31 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$224 |
$8,312.13 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$328 |
$5,196 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$98 |
$1,948.50 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$98 |
$1,916.56 |
1.0× |
| Ultrasound, transvaginal (76830) |
$98 |
$1,695.57 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$77 |
$1,063.26 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$99 |
$1,076.77 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$82 |
$983.46 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$311.85 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$535.32 |
0.9× |
| Lipid panel (80061) |
$13 |
$165.75 |
1.0× |
| Renal function panel (80069) |
$8 |
$378.16 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$278.70 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$49.11 |
0.9× |
| PSA, total (84153) |
$18 |
$333.95 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$305.70 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$119.10 |
0.9× |
| CBC, automated (85027) |
$6 |
$119.10 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$142.42 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$110.49 |
1.0× |
| Left heart catheterization (93452) |
$3,054 |
$13,762.30 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$809 |
$10,265.50 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$27 |
$278.24 |
0.9× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$876.63 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$926.98 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$1,319.87 |
— |