| Breast lesion removal (open) (19120) |
$637.50 |
$850 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$477.75 |
$637 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$222 |
$296 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$249.75 |
$333 |
0.3× |
| Diagnostic colonoscopy (45378) |
$334.50 |
$446 |
0.4× |
| Colonoscopy with biopsy (45380) |
$360.75 |
$481 |
0.3× |
| Colonoscopy with lesion removal (45385) |
$459 |
$612 |
0.4× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,163.25 |
$1,551 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$918.75 |
$1,225 |
0.3× |
| Obstetric care, vaginal delivery (global) (59400) |
$3,252.75 |
$4,337 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$3,588 |
$4,784 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$3,401.25 |
$4,535 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$558.38 |
$744.50 |
0.6× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$777 |
$1,036 |
0.9× |
| CT head/brain without contrast (70450) |
$519 |
$692 |
5.0× |
| MRI brain without contrast (70551) |
$794.25 |
$1,059 |
3.4× |
| MRI brain with contrast (70552) |
$861.38 |
$1,148.50 |
2.5× |
| MRI brain without and with contrast (70553) |
$1,246.12 |
$1,661.50 |
3.6× |
| X-ray lower spine, 4+ views (72110) |
$186.75 |
$249 |
1.8× |
| MRI lumbar spine without contrast (72148) |
$832.12 |
$1,109.50 |
3.5× |
| CT pelvis with contrast (72193) |
$559.12 |
$745.50 |
3.2× |
| MRI lower-extremity joint without contrast (73721) |
$858.38 |
$1,144.50 |
3.6× |
| CT abdomen and pelvis with contrast (74177) |
$1,049.25 |
$1,399 |
3.0× |
| Ultrasound, abdomen complete (76700) |
$304.88 |
$406.50 |
3.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$343.12 |
$457.50 |
3.3× |
| Ultrasound, transvaginal (76830) |
$238.88 |
$318.50 |
2.3× |
| Mammography, one breast (diagnostic) (77065) |
$205.88 |
$274.50 |
2.4× |
| Mammography, both breasts (diagnostic) (77066) |
$274.50 |
$366 |
2.5× |
| Mammography, screening (bilateral) (77067) |
$244.50 |
$326 |
2.7× |
| Basic metabolic panel (80048) |
$42 |
$56 |
5.0× |
| Comprehensive metabolic panel (80053) |
$56.25 |
$75 |
5.3× |
| Obstetric panel (80055) |
$323.25 |
$431 |
6.8× |
| Lipid panel (80061) |
$56.25 |
$75 |
4.2× |
| Renal function panel (80069) |
$90 |
$120 |
10.4× |
| Hepatic function panel (80076) |
$29.25 |
$39 |
3.6× |
| PSA, total (84153) |
$86.25 |
$115 |
4.7× |
| Thyroid stimulating hormone (TSH) (84443) |
$76.50 |
$102 |
4.6× |
| CBC with automated differential (85025) |
$80.25 |
$107 |
10.3× |
| CBC, automated (85027) |
$54 |
$72 |
8.3× |
| Prothrombin time (PT) (85610) |
$43.88 |
$58.50 |
10.2× |
| Partial thromboplastin time (PTT) (85730) |
$102.38 |
$136.50 |
17.0× |
| Psychotherapy, 30 minutes (90832) |
$51.75 |
$69 |
0.3× |
| Psychotherapy, 45 minutes (90834) |
$68.25 |
$91 |
0.4× |
| Psychotherapy, 60 minutes (90837) |
$102.75 |
$137 |
0.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$82.50 |
$110 |
0.5× |
| Family psychotherapy, with patient (50 min) (90847) |
$86.25 |
$115 |
0.5× |
| Group psychotherapy (90853) |
$21 |
$28 |
0.2× |
| Sleep study (attended polysomnography) (95810) |
$2,058 |
$2,744 |
2.4× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$91.50 |
$122 |
3.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$88.50 |
$118 |
0.7× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$138 |
$184 |
1.0× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$168 |
$224 |
1.3× |
| Preventive visit, new patient (age 18–39) (99385) |
$242.25 |
$323 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$240.75 |
$321 |
— |