| Breast lesion removal (open) (19120) |
$802.80 |
$1,338 |
0.2× |
| Knee arthroscopy with meniscectomy (29881) |
$986.40 |
$1,644 |
0.3× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$1,050 |
$1,750 |
0.2× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$660 |
$1,100 |
0.8× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$720 |
$1,200 |
0.9× |
| Diagnostic colonoscopy (45378) |
$673.20 |
$1,122 |
0.8× |
| Colonoscopy with biopsy (45380) |
$734.40 |
$1,224 |
0.7× |
| Colonoscopy with lesion removal (45385) |
$918 |
$1,530 |
0.8× |
Laparoscopic gallbladder removal (47562)
unusually low: confirm this is the full procedure |
$1,683 |
$2,805 |
0.3× |
| Inguinal hernia repair (age 5+) (49505) |
$1,002.60 |
$1,671 |
0.3× |
| CT head/brain without contrast (70450) |
$1,380 |
$2,300 |
14.4× |
| MRI brain without contrast (70551) |
$1,980 |
$3,300 |
9.0× |
| MRI brain with contrast (70552) |
$1,800 |
$3,000 |
5.6× |
| MRI brain without and with contrast (70553) |
$2,400 |
$4,000 |
7.5× |
| X-ray lower spine, 4+ views (72110) |
$360 |
$600 |
3.7× |
| MRI lumbar spine without contrast (72148) |
$1,980 |
$3,300 |
9.0× |
| CT pelvis with contrast (72193) |
$1,500 |
$2,500 |
9.3× |
| MRI lower-extremity joint without contrast (73721) |
$1,980 |
$3,300 |
9.0× |
| CT abdomen and pelvis with contrast (74177) |
$2,733 |
$4,555 |
8.5× |
| Ultrasound, abdomen complete (76700) |
$496.20 |
$827 |
5.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$408 |
$680 |
4.2× |
| Ultrasound, transvaginal (76830) |
$360 |
$600 |
3.7× |
| Mammography, one breast (diagnostic) (77065) |
$181.20 |
$302 |
2.1× |
| Mammography, both breasts (diagnostic) (77066) |
$219.60 |
$366 |
2.0× |
| Mammography, screening (bilateral) (77067) |
$172.80 |
$288 |
1.9× |
| Basic metabolic panel (80048) |
$85.20 |
$142 |
10.1× |
| Comprehensive metabolic panel (80053) |
$138 |
$230 |
13.1× |
| Lipid panel (80061) |
$99 |
$165 |
7.4× |
| Renal function panel (80069) |
$97.80 |
$163 |
11.3× |
| Hepatic function panel (80076) |
$150 |
$250 |
18.4× |
| Urinalysis, non-automated, without microscopy (81002) |
$15.60 |
$26 |
4.5× |
| PSA, total (84153) |
$109.50 |
$182.50 |
6.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$131.40 |
$219 |
7.8× |
| CBC with automated differential (85025) |
$66 |
$110 |
8.5× |
| CBC, automated (85027) |
$56.40 |
$94 |
8.7× |
| Prothrombin time (PT) (85610) |
$40.20 |
$67 |
9.4× |
| Partial thromboplastin time (PTT) (85730) |
$75 |
$125 |
12.5× |
| Psychotherapy, 30 minutes (90832) |
$142.80 |
$238 |
0.9× |
| Psychotherapy, 45 minutes (90834) |
$195 |
$325 |
1.2× |
| Family psychotherapy, with patient (50 min) (90847) |
$247.20 |
$412 |
1.5× |
| Group psychotherapy (90853) |
$126.60 |
$211 |
1.4× |
| Electrocardiogram (ECG), complete (93000) |
$149.40 |
$249 |
2.8× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$70.80 |
$118 |
2.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$118.50 |
$197.50 |
1.0× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$160.50 |
$267.50 |
1.3× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$198 |
$330 |
1.6× |
| Office consultation (low complexity, ~30 min) (99243) |
$160.20 |
$267 |
1.3× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$229.80 |
$383 |
1.9× |
| Preventive visit, new patient (age 18–39) (99385) |
$145.80 |
$243 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$165 |
$275 |
— |