| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,028.40 |
$2,571 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,906.40 |
$4,766 |
1.9× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,044.80 |
$2,612 |
1.1× |
| CT head/brain without contrast (70450) |
$1,044.40 |
$2,611 |
9.0× |
| MRI brain without contrast (70551) |
$1,096 |
$2,740 |
4.1× |
| MRI brain with contrast (70552) |
$1,523.60 |
$3,809 |
3.9× |
| MRI brain without and with contrast (70553) |
$1,797.60 |
$4,494 |
4.6× |
| X-ray lower spine, 4+ views (72110) |
$671.60 |
$1,679 |
5.8× |
| MRI lumbar spine without contrast (72148) |
$1,433.20 |
$3,583 |
5.4× |
| CT pelvis with contrast (72193) |
$1,500 |
$3,750 |
7.7× |
| MRI lower-extremity joint without contrast (73721) |
$1,254.40 |
$3,136 |
4.7× |
| CT abdomen and pelvis with contrast (74177) |
$2,411.60 |
$6,029 |
6.2× |
| Ultrasound, abdomen complete (76700) |
$468.80 |
$1,172 |
4.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$404.40 |
$1,011 |
3.5× |
| Ultrasound, transvaginal (76830) |
$334.80 |
$837 |
2.9× |
| Mammography, one breast (diagnostic) (77065) |
$186 |
$465 |
2.2× |
| Mammography, both breasts (diagnostic) (77066) |
$277.20 |
$693 |
2.5× |
| Mammography, screening (bilateral) (77067) |
$150 |
$375 |
1.6× |
| Basic metabolic panel (80048) |
$36.80 |
$92 |
4.3× |
| Comprehensive metabolic panel (80053) |
$114.80 |
$287 |
10.9× |
| Obstetric panel (80055) |
$80.40 |
$201 |
1.7× |
| Lipid panel (80061) |
$96.40 |
$241 |
7.2× |
| Renal function panel (80069) |
$74.80 |
$187 |
8.6× |
| Hepatic function panel (80076) |
$88.40 |
$221 |
10.8× |
| Urinalysis, non-automated, without microscopy (81002) |
$27.20 |
$68 |
7.8× |
| PSA, total (84153) |
$69.20 |
$173 |
3.8× |
| Thyroid stimulating hormone (TSH) (84443) |
$60.40 |
$151 |
3.6× |
| CBC with automated differential (85025) |
$66.40 |
$166 |
8.5× |
| CBC, automated (85027) |
$48.80 |
$122 |
7.5× |
| Prothrombin time (PT) (85610) |
$37.60 |
$94 |
8.8× |
| Partial thromboplastin time (PTT) (85730) |
$46.40 |
$116 |
7.7× |
| Psychotherapy, 30 minutes (90832) |
$186 |
$465 |
0.9× |
| Psychotherapy, 45 minutes (90834) |
$145.60 |
$364 |
0.7× |
| Psychotherapy, 60 minutes (90837) |
$269.60 |
$674 |
1.4× |
| Family psychotherapy, with patient (50 min) (90847) |
$210.80 |
$527 |
1.1× |
| Group psychotherapy (90853) |
$130.40 |
$326 |
1.2× |
| Left heart catheterization (93452) |
$3,682.80 |
$9,207 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$3,205.20 |
$8,013 |
3.3× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$64.40 |
$161 |
2.2× |