| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$6,600 |
$16,500 |
1.3× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,125.20 |
$2,813 |
1.4× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,020.40 |
$2,551 |
1.3× |
| Diagnostic colonoscopy (45378) |
$1,094 |
$2,735 |
1.3× |
| Colonoscopy with biopsy (45380) |
$1,338.80 |
$3,347 |
1.3× |
| Colonoscopy with lesion removal (45385) |
$1,338.80 |
$3,347 |
1.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,053.60 |
$2,634 |
1.4× |
| Cataract removal with lens insertion (66984) |
$2,669.20 |
$6,673 |
1.3× |
| CT head/brain without contrast (70450) |
$283.80 |
$709.50 |
3.1× |
| MRI brain without contrast (70551) |
$373.60 |
$934 |
1.8× |
| MRI brain with contrast (70552) |
$589.60 |
$1,474 |
1.9× |
| MRI brain without and with contrast (70553) |
$589.60 |
$1,474 |
1.9× |
| X-ray lower spine, 4+ views (72110) |
$137.60 |
$344 |
1.5× |
| MRI lumbar spine without contrast (72148) |
$373.63 |
$934.08 |
1.8× |
| CT pelvis with contrast (72193) |
$439.60 |
$1,099 |
2.9× |
| MRI lower-extremity joint without contrast (73721) |
$373.60 |
$934 |
1.8× |
| CT abdomen and pelvis with contrast (74177) |
$439.60 |
$1,099 |
1.4× |
| Ultrasound, abdomen complete (76700) |
$220.80 |
$552 |
2.4× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$160.80 |
$402 |
1.8× |
| Ultrasound, transvaginal (76830) |
$131.60 |
$329 |
1.4× |
| Mammography, one breast (diagnostic) (77065) |
$151.74 |
$379.35 |
1.8× |
| Mammography, both breasts (diagnostic) (77066) |
$191.10 |
$477.75 |
1.7× |
| Basic metabolic panel (80048) |
$50 |
$125 |
5.9× |
| Comprehensive metabolic panel (80053) |
$67.20 |
$168 |
6.4× |
| Lipid panel (80061) |
$69.60 |
$174 |
5.2× |
| Renal function panel (80069) |
$56.40 |
$141 |
6.5× |
| Hepatic function panel (80076) |
$57.20 |
$143 |
7.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.40 |
$11 |
1.3× |
| PSA, total (84153) |
$77.20 |
$193 |
4.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$56.80 |
$142 |
3.4× |
| CBC with automated differential (85025) |
$25.60 |
$64 |
3.3× |
| CBC, automated (85027) |
$28.80 |
$72 |
4.5× |
| Prothrombin time (PT) (85610) |
$32.80 |
$82 |
7.6× |
| Partial thromboplastin time (PTT) (85730) |
$46.80 |
$117 |
7.8× |
| Psychotherapy, 30 minutes (90832) |
$78.80 |
$197 |
0.5× |
| Psychotherapy, 45 minutes (90834) |
$104.40 |
$261 |
0.7× |
| Psychotherapy, 60 minutes (90837) |
$153.60 |
$384 |
1.0× |
| Family psychotherapy, without patient (50 min) (90846) |
$117.60 |
$294 |
0.8× |
| Family psychotherapy, with patient (50 min) (90847) |
$33.60 |
$84 |
0.2× |
| Group psychotherapy (90853) |
$28 |
$70 |
0.3× |
| Electrocardiogram (ECG), complete (93000) |
$16 |
$40 |
0.3× |
| Sleep study (attended polysomnography) (95810) |
$1,161.60 |
$2,904 |
1.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$44 |
$110 |
1.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$102.40 |
$256 |
0.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$166 |
$415 |
1.4× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$210.40 |
$526 |
1.8× |
| Preventive visit, new patient (age 18–39) (99385) |
$106.80 |
$267 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$129.20 |
$323 |
— |