| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,150 |
$2,300 |
1.4× |
| CT head/brain without contrast (70450) |
$883 |
$1,766 |
9.3× |
| MRI brain without contrast (70551) |
$1,094.50 |
$2,189 |
5.1× |
| MRI brain with contrast (70552) |
$1,346.50 |
$2,693 |
4.3× |
| MRI brain without and with contrast (70553) |
$1,599.50 |
$3,199 |
5.1× |
| X-ray lower spine, 4+ views (72110) |
$269 |
$538 |
2.8× |
| MRI lumbar spine without contrast (72148) |
$1,160.50 |
$2,321 |
5.4× |
| CT pelvis with contrast (72193) |
$1,176 |
$2,352 |
7.4× |
| MRI lower-extremity joint without contrast (73721) |
$1,287 |
$2,574 |
6.0× |
| CT abdomen and pelvis with contrast (74177) |
$1,328.50 |
$2,657 |
4.2× |
| Ultrasound, abdomen complete (76700) |
$590 |
$1,180 |
6.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$379 |
$758 |
4.0× |
| Ultrasound, transvaginal (76830) |
$437.50 |
$875 |
4.6× |
| Mammography, one breast (diagnostic) (77065) |
$187 |
$374 |
2.2× |
| Mammography, both breasts (diagnostic) (77066) |
$187 |
$374 |
1.7× |
| Mammography, screening (bilateral) (77067) |
$106.50 |
$213 |
1.2× |
| Basic metabolic panel (80048) |
$81 |
$162 |
9.6× |
| Comprehensive metabolic panel (80053) |
$125 |
$250 |
11.8× |
| Lipid panel (80061) |
$88.50 |
$177 |
6.6× |
| Renal function panel (80069) |
$104 |
$208 |
12.0× |
| Hepatic function panel (80076) |
$122 |
$244 |
14.9× |
| Urinalysis, non-automated, without microscopy (81002) |
$54.50 |
$109 |
15.7× |
| PSA, total (84153) |
$71.07 |
$142.14 |
3.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$58 |
$116 |
3.5× |
| CBC with automated differential (85025) |
$50.50 |
$101 |
6.5× |
| CBC, automated (85027) |
$62.50 |
$125 |
9.7× |
| Prothrombin time (PT) (85610) |
$56 |
$112 |
13.1× |
| Partial thromboplastin time (PTT) (85730) |
$64 |
$128 |
10.6× |
| Psychotherapy, 30 minutes (90832) |
$140.50 |
$281 |
0.9× |
| Psychotherapy, 45 minutes (90834) |
$190 |
$380 |
1.2× |
| Psychotherapy, 60 minutes (90837) |
$201.50 |
$403 |
1.3× |
| Family psychotherapy, without patient (50 min) (90846) |
$162.25 |
$324.50 |
1.0× |
| Family psychotherapy, with patient (50 min) (90847) |
$165 |
$330 |
1.0× |
| Group psychotherapy (90853) |
$93.50 |
$187 |
1.0× |
| Left heart catheterization (93452) |
$6,371 |
$12,742 |
2.2× |
| Sleep study (attended polysomnography) (95810) |
$1,584.50 |
$3,169 |
2.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$47.50 |
$95 |
1.6× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$118 |
$236 |
1.0× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$150.25 |
$300.50 |
1.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$254.50 |
$509 |
2.1× |