| Breast lesion removal (open) (19120) |
$2,925 |
$4,500 |
0.8× |
| Knee arthroscopy with meniscectomy (29881) |
$2,925 |
$4,500 |
1.0× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$2,925 |
$4,500 |
0.5× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,411.80 |
$2,172 |
1.7× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,415.70 |
$2,178 |
1.7× |
| Diagnostic colonoscopy (45378) |
$1,462.50 |
$2,250 |
1.7× |
| Colonoscopy with biopsy (45380) |
$2,254.20 |
$3,468 |
2.0× |
| Colonoscopy with lesion removal (45385) |
$1,453.08 |
$2,235.50 |
1.3× |
| Laparoscopic gallbladder removal (47562) |
$5,777.20 |
$8,888 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$4,387.50 |
$6,750 |
1.3× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$429.65 |
$661 |
0.5× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,538.88 |
$2,367.50 |
1.9× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$1,177.80 |
$1,812 |
2.3× |
| Cataract removal with lens insertion (66984) |
$1,462.50 |
$2,250 |
0.7× |
| CT head/brain without contrast (70450) |
$1,257.75 |
$1,935 |
13.1× |
| MRI brain without contrast (70551) |
$1,677 |
$2,580 |
7.6× |
| MRI brain without and with contrast (70553) |
$2,477.80 |
$3,812 |
7.7× |
| X-ray lower spine, 4+ views (72110) |
$321.10 |
$494 |
3.3× |
| MRI lumbar spine without contrast (72148) |
$1,827.80 |
$2,812 |
8.3× |
| CT pelvis with contrast (72193) |
$1,527.50 |
$2,350 |
9.5× |
| MRI lower-extremity joint without contrast (73721) |
$1,677 |
$2,580 |
7.6× |
| CT abdomen and pelvis with contrast (74177) |
$1,665.30 |
$2,562 |
5.2× |
| Ultrasound, abdomen complete (76700) |
$549.25 |
$845 |
5.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$549.25 |
$845 |
5.7× |
| Ultrasound, transvaginal (76830) |
$502.45 |
$773 |
5.2× |
| Mammography, one breast (diagnostic) (77065) |
$237.25 |
$365 |
2.8× |
| Mammography, both breasts (diagnostic) (77066) |
$297.70 |
$458 |
2.7× |
| Mammography, screening (bilateral) (77067) |
$268.45 |
$413 |
2.9× |
| Basic metabolic panel (80048) |
$104 |
$160 |
12.3× |
| Comprehensive metabolic panel (80053) |
$70.20 |
$108 |
6.6× |
| Lipid panel (80061) |
$93.60 |
$144 |
7.0× |
| Renal function panel (80069) |
$108.55 |
$167 |
12.5× |
| Hepatic function panel (80076) |
$84.50 |
$130 |
10.3× |
| Urinalysis, non-automated, with microscopy (81000) |
$13 |
$20 |
3.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$11.05 |
$17 |
3.2× |
| PSA, total (84153) |
$66.62 |
$102.50 |
3.6× |
| Thyroid stimulating hormone (TSH) (84443) |
$70.20 |
$108 |
4.2× |
| CBC with automated differential (85025) |
$52.65 |
$81 |
6.8× |
| CBC, automated (85027) |
$68.90 |
$106 |
10.6× |
| Prothrombin time (PT) (85610) |
$41.60 |
$64 |
9.7× |
| Partial thromboplastin time (PTT) (85730) |
$60.45 |
$93 |
10.1× |
| Electrocardiogram (ECG), complete (93000) |
$85.15 |
$131 |
1.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$71.82 |
$110.50 |
2.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$130 |
$200 |
1.1× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$196.95 |
$303 |
1.6× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$252.20 |
$388 |
2.1× |