| Upper GI endoscopy (EGD), diagnostic (43235) |
$741.60 |
$1,854 |
0.9× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$741.60 |
$1,854 |
0.9× |
| Diagnostic colonoscopy (45378) |
$920 |
$2,300 |
1.1× |
| Colonoscopy with biopsy (45380) |
$920 |
$2,300 |
0.9× |
| Colonoscopy with lesion removal (45385) |
$920 |
$2,300 |
0.9× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$738.40 |
$1,846 |
1.0× |
| CT head/brain without contrast (70450) |
$370.80 |
$927 |
4.1× |
| MRI brain without contrast (70551) |
$597.20 |
$1,493 |
2.9× |
| MRI brain with contrast (70552) |
$1,028 |
$2,570 |
3.4× |
| MRI brain without and with contrast (70553) |
$942 |
$2,355 |
3.1× |
| X-ray lower spine, 4+ views (72110) |
$167.60 |
$419 |
1.9× |
| MRI lumbar spine without contrast (72148) |
$620.40 |
$1,551 |
3.0× |
| CT pelvis with contrast (72193) |
$580.40 |
$1,451 |
3.8× |
| MRI lower-extremity joint without contrast (73721) |
$597.20 |
$1,493 |
2.9× |
| CT abdomen and pelvis with contrast (74177) |
$717.60 |
$1,794 |
2.4× |
| Ultrasound, abdomen complete (76700) |
$241.60 |
$604 |
2.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$210 |
$525 |
2.3× |
| Ultrasound, transvaginal (76830) |
$241.60 |
$604 |
2.7× |
| Mammography, one breast (diagnostic) (77065) |
$121.60 |
$304 |
1.4× |
| Mammography, both breasts (diagnostic) (77066) |
$153.60 |
$384 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$123.60 |
$309 |
1.4× |
| Basic metabolic panel (80048) |
$19.60 |
$49 |
2.3× |
| Comprehensive metabolic panel (80053) |
$28.40 |
$71 |
2.7× |
| Lipid panel (80061) |
$36 |
$90 |
2.7× |
| Renal function panel (80069) |
$20.40 |
$51 |
2.4× |
| Hepatic function panel (80076) |
$19.20 |
$48 |
2.4× |
| PSA, total (84153) |
$36.80 |
$92 |
2.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$42.40 |
$106 |
2.5× |
| CBC with automated differential (85025) |
$21.20 |
$53 |
2.7× |
| CBC, automated (85027) |
$18.40 |
$46 |
2.8× |
| Prothrombin time (PT) (85610) |
$9.20 |
$23 |
2.1× |
| Partial thromboplastin time (PTT) (85730) |
$14 |
$35 |
2.3× |
| Sleep study (attended polysomnography) (95810) |
$791.60 |
$1,979 |
1.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$64.80 |
$162 |
2.2× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$93.20 |
$233 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$202.40 |
$506 |
1.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$240 |
$600 |
2.1× |