| Breast lesion removal (open) (19120) |
$2,807.40 |
$4,679 |
0.8× |
| Shoulder arthroscopy with decompression (29826) |
$4,523.40 |
$7,539 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$4,545 |
$7,575 |
1.5× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$2,807.40 |
$4,679 |
0.5× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,455.60 |
$2,426 |
1.7× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,455.60 |
$2,426 |
1.7× |
| Diagnostic colonoscopy (45378) |
$1,455.60 |
$2,426 |
1.7× |
| Colonoscopy with biopsy (45380) |
$1,455.60 |
$2,426 |
1.3× |
| Colonoscopy with lesion removal (45385) |
$1,455.60 |
$2,426 |
1.3× |
| Laparoscopic gallbladder removal (47562) |
$8,391 |
$13,985 |
1.5× |
| Inguinal hernia repair (age 5+) (49505) |
$4,030.80 |
$6,718 |
1.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$721.80 |
$1,203 |
0.9× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,740 |
$2,900 |
2.1× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$1,246.80 |
$2,078 |
2.4× |
| Cataract removal with lens insertion (66984) |
$5,554.50 |
$9,257.50 |
2.6× |
| CT head/brain without contrast (70450) |
$1,249.50 |
$2,082.50 |
12.8× |
| MRI brain without contrast (70551) |
$1,710 |
$2,850 |
7.7× |
| MRI brain with contrast (70552) |
$1,887.60 |
$3,146 |
5.8× |
| MRI brain without and with contrast (70553) |
$2,497.50 |
$4,162.50 |
7.7× |
| X-ray lower spine, 4+ views (72110) |
$434.70 |
$724.50 |
4.5× |
| MRI lumbar spine without contrast (72148) |
$1,786.50 |
$2,977.50 |
8.1× |
| CT pelvis with contrast (72193) |
$1,410.30 |
$2,350.50 |
8.6× |
| MRI lower-extremity joint without contrast (73721) |
$1,749.90 |
$2,916.50 |
7.9× |
| CT abdomen and pelvis with contrast (74177) |
$2,960.40 |
$4,934 |
9.1× |
| Ultrasound, abdomen complete (76700) |
$987 |
$1,645 |
10.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$409.80 |
$683 |
4.2× |
| Ultrasound, transvaginal (76830) |
$651 |
$1,085 |
6.7× |
| Mammography, one breast (diagnostic) (77065) |
$123.90 |
$206.50 |
1.4× |
| Mammography, both breasts (diagnostic) (77066) |
$171.60 |
$286 |
1.6× |
| Mammography, screening (bilateral) (77067) |
$107.10 |
$178.50 |
1.2× |
| Basic metabolic panel (80048) |
$123 |
$205 |
14.5× |
| Comprehensive metabolic panel (80053) |
$134.40 |
$224 |
12.7× |
| Obstetric panel (80055) |
$156 |
$260 |
3.3× |
| Lipid panel (80061) |
$85.20 |
$142 |
6.4× |
| Renal function panel (80069) |
$64.80 |
$108 |
7.5× |
| Hepatic function panel (80076) |
$58.80 |
$98 |
7.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$23.10 |
$38.50 |
6.6× |
| PSA, total (84153) |
$42.60 |
$71 |
2.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$100.20 |
$167 |
6.0× |
| CBC with automated differential (85025) |
$86.40 |
$144 |
11.1× |
| CBC, automated (85027) |
$39.60 |
$66 |
6.1× |
| Prothrombin time (PT) (85610) |
$30 |
$50 |
7.0× |
| Partial thromboplastin time (PTT) (85730) |
$51.60 |
$86 |
8.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$190.20 |
$317 |
1.2× |
| Family psychotherapy, with patient (50 min) (90847) |
$190.20 |
$317 |
1.2× |
| Group psychotherapy (90853) |
$158.40 |
$264 |
1.7× |
| Left heart catheterization (93452) |
$3,351.60 |
$5,586 |
1.1× |
| Sleep study (attended polysomnography) (95810) |
$1,858.80 |
$3,098 |
2.3× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$67.50 |
$112.50 |
2.3× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$133.20 |
$222 |
1.1× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$226.80 |
$378 |
1.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$295.20 |
$492 |
2.4× |