| Upper GI endoscopy (EGD), diagnostic (43235) |
$848.50 |
$1,697 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$714 |
$1,428 |
0.9× |
| CT head/brain without contrast (70450) |
$439 |
$878 |
4.5× |
| MRI brain without contrast (70551) |
$1,401 |
$2,802 |
6.3× |
| MRI brain with contrast (70552) |
$1,212.50 |
$2,425 |
3.7× |
| MRI brain without and with contrast (70553) |
$1,875.50 |
$3,751 |
5.7× |
| X-ray lower spine, 4+ views (72110) |
$199.50 |
$399 |
2.0× |
| MRI lumbar spine without contrast (72148) |
$1,401 |
$2,802 |
6.3× |
| CT pelvis with contrast (72193) |
$551.50 |
$1,103 |
3.4× |
| MRI lower-extremity joint without contrast (73721) |
$1,401 |
$2,802 |
6.3× |
| CT abdomen and pelvis with contrast (74177) |
$1,103 |
$2,206 |
3.4× |
| Ultrasound, abdomen complete (76700) |
$847 |
$1,694 |
8.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$178 |
$356 |
1.8× |
| Ultrasound, transvaginal (76830) |
$690 |
$1,380 |
7.0× |
| Mammography, one breast (diagnostic) (77065) |
$304 |
$608 |
3.5× |
| Mammography, both breasts (diagnostic) (77066) |
$350 |
$700 |
3.2× |
| Mammography, screening (bilateral) (77067) |
$324 |
$648 |
3.6× |
| Basic metabolic panel (80048) |
$129.75 |
$259.50 |
15.3× |
| Comprehensive metabolic panel (80053) |
$140 |
$280 |
13.3× |
| Obstetric panel (80055) |
$288.50 |
$577 |
6.0× |
| Lipid panel (80061) |
$15.50 |
$31 |
1.2× |
| Renal function panel (80069) |
$102 |
$204 |
11.8× |
| Hepatic function panel (80076) |
$95.50 |
$191 |
11.7× |
| Urinalysis, non-automated, with microscopy (81000) |
$5 |
$10 |
1.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$8.50 |
$17 |
2.4× |
| PSA, total (84153) |
$51.25 |
$102.50 |
2.8× |
| Thyroid stimulating hormone (TSH) (84443) |
$56.25 |
$112.50 |
3.3× |
| CBC with automated differential (85025) |
$38.25 |
$76.50 |
4.9× |
| CBC, automated (85027) |
$66 |
$132 |
10.2× |
| Prothrombin time (PT) (85610) |
$24.50 |
$49 |
5.7× |
| Partial thromboplastin time (PTT) (85730) |
$24.25 |
$48.50 |
4.0× |
| Psychotherapy, 30 minutes (90832) |
$56 |
$112 |
0.3× |
| Psychotherapy, 45 minutes (90834) |
$74 |
$148 |
0.4× |
| Psychotherapy, 60 minutes (90837) |
$109 |
$218 |
0.7× |
| Family psychotherapy, without patient (50 min) (90846) |
$70.50 |
$141 |
0.4× |
| Family psychotherapy, with patient (50 min) (90847) |
$74 |
$148 |
0.4× |
| Group psychotherapy (90853) |
$20 |
$40 |
0.2× |
| Electrocardiogram (ECG), complete (93000) |
$23 |
$46 |
0.4× |
| Left heart catheterization (93452) |
$3,962.50 |
$7,925 |
1.3× |
| Sleep study (attended polysomnography) (95810) |
$3,492 |
$6,984 |
4.3× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$99 |
$198 |
3.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$170.50 |
$341 |
1.4× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$197 |
$394 |
1.6× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$247 |
$494 |
2.0× |
| Office consultation (low complexity, ~30 min) (99243) |
$105.50 |
$211 |
0.8× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$165 |
$330 |
1.3× |
| Preventive visit, new patient (age 18–39) (99385) |
$89.75 |
$179.50 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$109.50 |
$219 |
— |