| Breast lesion removal (open) (19120) |
$552 |
$1,104 |
0.2× |
| Shoulder arthroscopy with decompression (29826) |
$261.50 |
$523 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$668.50 |
$1,337 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$378.50 |
$757 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$157 |
$314 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$413.50 |
$827 |
0.5× |
| Diagnostic colonoscopy (45378) |
$447.50 |
$895 |
0.5× |
| Colonoscopy with biopsy (45380) |
$555 |
$1,110 |
0.5× |
| Colonoscopy with lesion removal (45385) |
$626.50 |
$1,253 |
0.6× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$764 |
$1,528 |
0.1× |
| Inguinal hernia repair (age 5+) (49505) |
$836.50 |
$1,673 |
0.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,046.72 |
$2,093.43 |
1.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,136.93 |
$2,273.86 |
1.4× |
| CT head/brain without contrast (70450) |
$907 |
$1,814 |
9.2× |
| MRI brain without contrast (70551) |
$1,518.50 |
$3,037 |
6.8× |
| MRI brain with contrast (70552) |
$1,704 |
$3,408 |
5.2× |
| MRI brain without and with contrast (70553) |
$1,976.50 |
$3,953 |
6.0× |
| X-ray lower spine, 4+ views (72110) |
$284.50 |
$569 |
2.9× |
| MRI lumbar spine without contrast (72148) |
$1,559.50 |
$3,119 |
7.0× |
| CT pelvis with contrast (72193) |
$1,176 |
$2,352 |
7.1× |
| MRI lower-extremity joint without contrast (73721) |
$1,512.50 |
$3,025 |
6.8× |
| CT abdomen and pelvis with contrast (74177) |
$1,635.50 |
$3,271 |
5.0× |
| Ultrasound, abdomen complete (76700) |
$456.50 |
$913 |
4.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$495.50 |
$991 |
5.1× |
| Ultrasound, transvaginal (76830) |
$336.50 |
$673 |
3.4× |
| Mammography, one breast (diagnostic) (77065) |
$130 |
$260 |
1.5× |
| Mammography, both breasts (diagnostic) (77066) |
$165 |
$330 |
1.5× |
| Mammography, screening (bilateral) (77067) |
$134.75 |
$269.50 |
1.5× |
| Basic metabolic panel (80048) |
$26 |
$52 |
3.1× |
| Comprehensive metabolic panel (80053) |
$34 |
$68 |
3.2× |
| Lipid panel (80061) |
$59.50 |
$119 |
4.4× |
| Renal function panel (80069) |
$86.50 |
$173 |
10.0× |
| Hepatic function panel (80076) |
$45 |
$90 |
5.5× |
| PSA, total (84153) |
$70 |
$140 |
3.8× |
| Thyroid stimulating hormone (TSH) (84443) |
$90.75 |
$181.50 |
5.4× |
| CBC with automated differential (85025) |
$23.50 |
$47 |
3.0× |
| CBC, automated (85027) |
$48.50 |
$97 |
7.5× |
| Prothrombin time (PT) (85610) |
$23 |
$46 |
5.4× |
| Partial thromboplastin time (PTT) (85730) |
$62 |
$124 |
10.3× |
| Psychotherapy, 30 minutes (90832) |
$114 |
$228 |
0.7× |
| Psychotherapy, 45 minutes (90834) |
$171.50 |
$343 |
1.0× |
| Psychotherapy, 60 minutes (90837) |
$264 |
$528 |
1.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$164 |
$328 |
1.0× |
| Family psychotherapy, with patient (50 min) (90847) |
$161 |
$322 |
1.0× |
| Group psychotherapy (90853) |
$186 |
$372 |
2.0× |
| Sleep study (attended polysomnography) (95810) |
$1,257.75 |
$2,515.50 |
1.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$99 |
$198 |
3.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$78.25 |
$156.50 |
0.6× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$106.75 |
$213.50 |
0.9× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$170.25 |
$340.50 |
1.4× |
| Office consultation (low complexity, ~30 min) (99243) |
$156.50 |
$313 |
1.3× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$197.50 |
$395 |
1.6× |