| Breast lesion removal (open) (19120) |
$1,100 |
$1,100 |
0.3× |
| Knee arthroscopy with meniscectomy (29881) |
$1,100 |
$1,100 |
0.4× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$607.20 |
$607.20 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$855.50 |
$855.50 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,186 |
$1,186 |
1.4× |
| Diagnostic colonoscopy (45378) |
$1,373 |
$1,373 |
1.6× |
| Colonoscopy with biopsy (45380) |
$1,154.15 |
$1,154.15 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,277.65 |
$1,277.65 |
1.2× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,610.10 |
$1,610.10 |
0.3× |
| Inguinal hernia repair (age 5+) (49505) |
$1,391.50 |
$1,391.50 |
0.4× |
| Obstetric care, vaginal delivery (global) (59400) |
$4,317.50 |
$4,317.50 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$4,592.50 |
$4,592.50 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$2,795.10 |
$2,795.10 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$103.50 |
$103.50 |
0.1× |
| Cataract removal with lens insertion (66984) |
$3,102 |
$3,102 |
1.5× |
| CT head/brain without contrast (70450) |
$992.20 |
$992.20 |
10.3× |
| MRI brain without contrast (70551) |
$1,892.90 |
$1,892.90 |
8.6× |
| MRI brain with contrast (70552) |
$2,362.80 |
$2,362.80 |
7.4× |
| MRI brain without and with contrast (70553) |
$1,987.70 |
$1,987.70 |
6.2× |
| X-ray lower spine, 4+ views (72110) |
$468.60 |
$468.60 |
4.9× |
| MRI lumbar spine without contrast (72148) |
$2,573 |
$2,573 |
11.7× |
| CT pelvis with contrast (72193) |
$1,578 |
$1,578 |
9.8× |
| MRI lower-extremity joint without contrast (73721) |
$2,526.70 |
$2,526.70 |
11.5× |
| CT abdomen and pelvis with contrast (74177) |
$3,085.50 |
$3,085.50 |
9.6× |
| Ultrasound, abdomen complete (76700) |
$519.20 |
$519.20 |
5.4× |
| Ultrasound, transvaginal (76830) |
$519.20 |
$519.20 |
5.4× |
| Mammography, one breast (diagnostic) (77065) |
$209 |
$209 |
2.4× |
| Mammography, both breasts (diagnostic) (77066) |
$251.90 |
$251.90 |
2.3× |
| Mammography, screening (bilateral) (77067) |
$143.95 |
$143.95 |
1.6× |
| Basic metabolic panel (80048) |
$29 |
$29 |
3.4× |
| Comprehensive metabolic panel (80053) |
$82.50 |
$82.50 |
7.8× |
| Obstetric panel (80055) |
$172.50 |
$172.50 |
3.6× |
| Lipid panel (80061) |
$90 |
$90 |
6.7× |
| Renal function panel (80069) |
$27 |
$27 |
3.1× |
| Hepatic function panel (80076) |
$58 |
$58 |
7.1× |
| Urinalysis, non-automated, without microscopy (81002) |
$14 |
$14 |
4.0× |
| PSA, total (84153) |
$136.40 |
$136.40 |
7.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$112.20 |
$112.20 |
6.7× |
| CBC with automated differential (85025) |
$28.50 |
$28.50 |
3.7× |
| CBC, automated (85027) |
$26.40 |
$26.40 |
4.1× |
| Prothrombin time (PT) (85610) |
$26.25 |
$26.25 |
6.1× |
| Partial thromboplastin time (PTT) (85730) |
$38 |
$38 |
6.3× |
| Electrocardiogram (ECG), complete (93000) |
$72.60 |
$72.60 |
1.3× |
| Sleep study (attended polysomnography) (95810) |
$3,836 |
$3,836 |
4.9× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$62 |
$62 |
2.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$230 |
$230 |
1.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$260 |
$260 |
2.1× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$300 |
$300 |
2.5× |
| Office consultation (low complexity, ~30 min) (99243) |
$230 |
$230 |
1.9× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$260 |
$260 |
2.1× |
| Preventive visit, new patient (age 18–39) (99385) |
$222.50 |
$222.50 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$185 |
$185 |
— |