Tonsillectomy and adenoidectomy (under age 12) (42820)
unusually low — confirm this is the full procedure |
$2,257.50 |
$4,515 |
0.4× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,231.50 |
$2,463 |
1.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,231.50 |
$2,463 |
1.3× |
| Diagnostic colonoscopy (45378) |
$1,287.50 |
$2,575 |
1.3× |
| Colonoscopy with biopsy (45380) |
$1,557.75 |
$3,115.50 |
1.2× |
| Colonoscopy with lesion removal (45385) |
$1,287.50 |
$2,575 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$4,991.50 |
$9,983 |
0.8× |
| Inguinal hernia repair (age 5+) (49505) |
$9,481.50 |
$18,963 |
2.5× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$740.50 |
$1,481 |
0.8× |
| CT head/brain without contrast (70450) |
$1,127 |
$2,254 |
10.2× |
| MRI brain without contrast (70551) |
$1,476 |
$2,952 |
5.9× |
| MRI brain with contrast (70552) |
$2,089.50 |
$4,179 |
5.7× |
| MRI brain without and with contrast (70553) |
$2,336.50 |
$4,673 |
6.3× |
| X-ray lower spine, 4+ views (72110) |
$296.75 |
$593.50 |
2.7× |
| MRI lumbar spine without contrast (72148) |
$1,602 |
$3,204 |
6.4× |
| CT pelvis with contrast (72193) |
$1,505.75 |
$3,011.50 |
8.1× |
| MRI lower-extremity joint without contrast (73721) |
$1,602 |
$3,204 |
6.4× |
| CT abdomen and pelvis with contrast (74177) |
$2,217.50 |
$4,435 |
6.0× |
| Ultrasound, abdomen complete (76700) |
$504.25 |
$1,008.50 |
4.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$385.50 |
$771 |
3.5× |
| Ultrasound, transvaginal (76830) |
$260 |
$520 |
2.4× |
| Mammography, one breast (diagnostic) (77065) |
$273.50 |
$547 |
3.2× |
| Mammography, both breasts (diagnostic) (77066) |
$326.50 |
$653 |
3.0× |
| Mammography, screening (bilateral) (77067) |
$220 |
$440 |
2.4× |
| Basic metabolic panel (80048) |
$75 |
$150 |
8.9× |
| Comprehensive metabolic panel (80053) |
$150.25 |
$300.50 |
14.2× |
| Obstetric panel (80055) |
$180 |
$360 |
3.8× |
| Lipid panel (80061) |
$62.50 |
$125 |
4.7× |
| Renal function panel (80069) |
$126 |
$252 |
14.5× |
| Hepatic function panel (80076) |
$102 |
$204 |
12.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$24.75 |
$49.50 |
7.1× |
| PSA, total (84153) |
$130 |
$260 |
7.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$47.50 |
$95 |
2.8× |
| CBC with automated differential (85025) |
$60.75 |
$121.50 |
7.8× |
| CBC, automated (85027) |
$50 |
$100 |
7.7× |
| Prothrombin time (PT) (85610) |
$36.50 |
$73 |
8.5× |
| Partial thromboplastin time (PTT) (85730) |
$59.50 |
$119 |
9.9× |
| Sleep study (attended polysomnography) (95810) |
$2,649.75 |
$5,299.50 |
2.9× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$223.50 |
$447 |
7.7× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$207.50 |
$415 |
1.5× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$315 |
$630 |
2.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$396.50 |
$793 |
2.8× |