| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,094 |
$2,188 |
1.3× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,341.50 |
$2,683 |
1.7× |
| CT head/brain without contrast (70450) |
$964.50 |
$1,929 |
10.2× |
| MRI brain without contrast (70551) |
$2,072.75 |
$4,145.50 |
9.6× |
| MRI brain with contrast (70552) |
$2,205.50 |
$4,411 |
7.0× |
| MRI brain without and with contrast (70553) |
$2,432.50 |
$4,865 |
7.7× |
| X-ray lower spine, 4+ views (72110) |
$75.50 |
$151 |
0.8× |
| MRI lumbar spine without contrast (72148) |
$1,713 |
$3,426 |
7.9× |
| CT pelvis with contrast (72193) |
$1,514.25 |
$3,028.50 |
9.5× |
| MRI lower-extremity joint without contrast (73721) |
$1,713 |
$3,426 |
7.9× |
| CT abdomen and pelvis with contrast (74177) |
$3,238 |
$6,476 |
10.2× |
| Ultrasound, abdomen complete (76700) |
$853 |
$1,706 |
9.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$193.75 |
$387.50 |
2.0× |
| Ultrasound, transvaginal (76830) |
$165.50 |
$331 |
1.7× |
| Mammography, one breast (diagnostic) (77065) |
$88 |
$176 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$266 |
$532 |
2.4× |
| Mammography, screening (bilateral) (77067) |
$221.75 |
$443.50 |
2.4× |
| Basic metabolic panel (80048) |
$22.86 |
$45.73 |
2.7× |
| Comprehensive metabolic panel (80053) |
$5.28 |
$10.56 |
0.5× |
| Obstetric panel (80055) |
$147 |
$294 |
3.1× |
| Lipid panel (80061) |
$36.60 |
$73.20 |
2.7× |
| Renal function panel (80069) |
$160.25 |
$320.50 |
18.5× |
| Hepatic function panel (80076) |
$53.50 |
$107 |
6.5× |
| PSA, total (84153) |
$43.10 |
$86.20 |
2.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$60 |
$120 |
3.6× |
| CBC with automated differential (85025) |
$3.89 |
$7.77 |
0.5× |
| CBC, automated (85027) |
$18.12 |
$36.24 |
2.8× |
| Prothrombin time (PT) (85610) |
$10.32 |
$20.64 |
2.4× |
| Partial thromboplastin time (PTT) (85730) |
$26.50 |
$53 |
4.4× |
| Left heart catheterization (93452) |
$3,933 |
$7,866 |
1.3× |
| Sleep study (attended polysomnography) (95810) |
$1,972.50 |
$3,945 |
2.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$63.50 |
$127 |
2.2× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$233 |
$466 |
1.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$413 |
$826 |
3.4× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$486.50 |
$973 |
4.0× |