Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$571.20 |
$952 |
0.1× |
| CT head/brain without contrast (70450) |
$1,561.80 |
$2,603 |
15.6× |
| MRI brain without contrast (70551) |
$3,243.60 |
$5,406 |
14.2× |
| MRI brain with contrast (70552) |
$3,649.80 |
$6,083 |
10.9× |
| MRI brain without and with contrast (70553) |
$4,664.40 |
$7,774 |
13.9× |
| X-ray lower spine, 4+ views (72110) |
$466.20 |
$777 |
4.6× |
| MRI lumbar spine without contrast (72148) |
$3,295.20 |
$5,492 |
14.4× |
| CT pelvis with contrast (72193) |
$2,554.20 |
$4,257 |
15.2× |
| MRI lower-extremity joint without contrast (73721) |
$3,060.60 |
$5,101 |
13.4× |
| CT abdomen and pelvis with contrast (74177) |
$4,600.80 |
$7,668 |
13.7× |
| Ultrasound, abdomen complete (76700) |
$933 |
$1,555 |
9.3× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$99.60 |
$166 |
1.0× |
| Ultrasound, transvaginal (76830) |
$883.80 |
$1,473 |
8.8× |
| Mammography, one breast (diagnostic) (77065) |
$475.20 |
$792 |
5.5× |
| Mammography, both breasts (diagnostic) (77066) |
$475.20 |
$792 |
4.3× |
| Mammography, screening (bilateral) (77067) |
$198.60 |
$331 |
2.2× |
| Basic metabolic panel (80048) |
$144 |
$240 |
17.0× |
| Comprehensive metabolic panel (80053) |
$171 |
$285 |
16.2× |
| Lipid panel (80061) |
$238.80 |
$398 |
17.8× |
| Renal function panel (80069) |
$210.60 |
$351 |
24.3× |
| Hepatic function panel (80076) |
$186 |
$310 |
22.8× |
| Urinalysis, non-automated, with microscopy (81000) |
$34.20 |
$57 |
8.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$24.90 |
$41.50 |
7.2× |
| PSA, total (84153) |
$184.20 |
$307 |
10.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$181.20 |
$302 |
10.8× |
| CBC with automated differential (85025) |
$108.60 |
$181 |
14.0× |
| CBC, automated (85027) |
$61.80 |
$103 |
9.6× |
| Prothrombin time (PT) (85610) |
$132.60 |
$221 |
30.9× |
| Partial thromboplastin time (PTT) (85730) |
$293.40 |
$489 |
48.8× |
| Electrocardiogram (ECG), complete (93000) |
$143.40 |
$239 |
2.5× |
| Sleep study (attended polysomnography) (95810) |
$3,745.80 |
$6,243 |
4.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$227.70 |
$379.50 |
7.8× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$114.60 |
$191 |
0.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$147.60 |
$246 |
1.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$196.50 |
$327.50 |
1.5× |
| Office consultation (low complexity, ~30 min) (99243) |
$75 |
$125 |
0.6× |
| Preventive visit, new patient (age 18–39) (99385) |
$115.80 |
$193 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$139.80 |
$233 |
— |