| Breast lesion removal (open) (19120) |
$690 |
$1,150 |
0.2× |
| Shoulder arthroscopy with decompression (29826) |
$330 |
$550 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,011 |
$1,685 |
0.3× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$402 |
$670 |
0.5× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$466.80 |
$778 |
0.6× |
| Diagnostic colonoscopy (45378) |
$534 |
$890 |
0.6× |
| Colonoscopy with biopsy (45380) |
$639.60 |
$1,066 |
0.6× |
| Colonoscopy with lesion removal (45385) |
$540 |
$900 |
0.5× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,155.60 |
$1,926 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$931.20 |
$1,552 |
0.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$165 |
$275 |
0.2× |
| CT head/brain without contrast (70450) |
$278.10 |
$463.50 |
2.9× |
| MRI brain without contrast (70551) |
$516.30 |
$860.50 |
2.4× |
| MRI brain with contrast (70552) |
$604.80 |
$1,008 |
1.9× |
| MRI brain without and with contrast (70553) |
$1,281 |
$2,135 |
4.1× |
| X-ray lower spine, 4+ views (72110) |
$123.90 |
$206.50 |
1.3× |
| MRI lumbar spine without contrast (72148) |
$531.60 |
$886 |
2.5× |
| CT pelvis with contrast (72193) |
$412.20 |
$687 |
2.6× |
| MRI lower-extremity joint without contrast (73721) |
$990 |
$1,650 |
4.6× |
| CT abdomen and pelvis with contrast (74177) |
$165 |
$275 |
0.5× |
| Ultrasound, abdomen complete (76700) |
$237 |
$395 |
2.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$162 |
$270 |
1.7× |
| Ultrasound, transvaginal (76830) |
$147.60 |
$246 |
1.6× |
| Mammography, one breast (diagnostic) (77065) |
$282.60 |
$471 |
3.3× |
| Mammography, both breasts (diagnostic) (77066) |
$358.20 |
$597 |
3.2× |
| Mammography, screening (bilateral) (77067) |
$324 |
$540 |
3.6× |
| Basic metabolic panel (80048) |
$28.80 |
$48 |
3.4× |
| Comprehensive metabolic panel (80053) |
$36 |
$60 |
3.4× |
| Lipid panel (80061) |
$40.80 |
$68 |
3.0× |
| Renal function panel (80069) |
$29.40 |
$49 |
3.4× |
| Hepatic function panel (80076) |
$27.60 |
$46 |
3.4× |
| Urinalysis, non-automated, with microscopy (81000) |
$10.80 |
$18 |
2.7× |
| PSA, total (84153) |
$62.40 |
$104 |
3.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$57 |
$95 |
3.4× |
| CBC with automated differential (85025) |
$28.50 |
$47.50 |
3.7× |
| CBC, automated (85027) |
$22.80 |
$38 |
3.5× |
| Prothrombin time (PT) (85610) |
$13.20 |
$22 |
3.1× |
| Partial thromboplastin time (PTT) (85730) |
$20.40 |
$34 |
3.4× |
| Psychotherapy, 30 minutes (90832) |
$51 |
$85 |
0.3× |
| Psychotherapy, 45 minutes (90834) |
$66 |
$110 |
0.4× |
| Psychotherapy, 60 minutes (90837) |
$102 |
$170 |
0.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$108 |
$180 |
0.7× |
| Family psychotherapy, with patient (50 min) (90847) |
$108 |
$180 |
0.7× |
| Group psychotherapy (90853) |
$125.40 |
$209 |
1.4× |
| Electrocardiogram (ECG), complete (93000) |
$36 |
$60 |
0.7× |
| Sleep study (attended polysomnography) (95810) |
$2,700 |
$4,500 |
3.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$55.20 |
$92 |
1.9× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$89.40 |
$149 |
0.7× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$153 |
$255 |
1.3× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$197.40 |
$329 |
1.6× |
| Office consultation (low complexity, ~30 min) (99243) |
$172.80 |
$288 |
1.4× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$244.80 |
$408 |
2.0× |
| Preventive visit, new patient (age 18–39) (99385) |
$115.80 |
$193 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$140.40 |
$234 |
— |