| Breast lesion removal (open) (19120) |
$621.60 |
$1,036 |
0.2× |
| Shoulder arthroscopy with decompression (29826) |
$204 |
$340 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$658.20 |
$1,097 |
0.2× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$346.80 |
$578 |
0.4× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$453 |
$755 |
0.6× |
| Diagnostic colonoscopy (45378) |
$411 |
$685 |
0.5× |
| Colonoscopy with biopsy (45380) |
$523.20 |
$872 |
0.5× |
| Colonoscopy with lesion removal (45385) |
$549 |
$915 |
0.5× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$783.60 |
$1,306 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$622.80 |
$1,038 |
0.2× |
Laparoscopic radical prostatectomy (55866)
likely a partial charge, not the full procedure |
$1,452 |
$2,420 |
0.2× |
| Obstetric care, vaginal delivery (global) (59400) |
$2,856.60 |
$4,761 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$3,153.60 |
$5,256 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$2,971.20 |
$4,952 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$298.80 |
$498 |
0.4× |
| CT head/brain without contrast (70450) |
$604.80 |
$1,008 |
6.7× |
| MRI brain without contrast (70551) |
$916.20 |
$1,527 |
4.5× |
| MRI brain without and with contrast (70553) |
$1,326 |
$2,210 |
4.4× |
| X-ray lower spine, 4+ views (72110) |
$257.40 |
$429 |
2.9× |
| MRI lumbar spine without contrast (72148) |
$916.20 |
$1,527 |
4.5× |
| CT pelvis with contrast (72193) |
$638.40 |
$1,064 |
4.2× |
| MRI lower-extremity joint without contrast (73721) |
$916.20 |
$1,527 |
4.5× |
| CT abdomen and pelvis with contrast (74177) |
$1,947.69 |
$3,246.15 |
6.5× |
| Ultrasound, abdomen complete (76700) |
$269.40 |
$449 |
3.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$216.90 |
$361.50 |
2.4× |
| Ultrasound, transvaginal (76830) |
$269.40 |
$449 |
3.0× |
| Mammography, one breast (diagnostic) (77065) |
$182.40 |
$304 |
2.1× |
| Mammography, both breasts (diagnostic) (77066) |
$216.60 |
$361 |
2.0× |
| Mammography, screening (bilateral) (77067) |
$182.40 |
$304 |
2.0× |
| Basic metabolic panel (80048) |
$28.20 |
$47 |
3.3× |
| Comprehensive metabolic panel (80053) |
$45.90 |
$76.50 |
4.3× |
| Lipid panel (80061) |
$37.80 |
$63 |
2.8× |
| Renal function panel (80069) |
$28.80 |
$48 |
3.3× |
| Hepatic function panel (80076) |
$27 |
$45 |
3.3× |
| Urinalysis, non-automated, with microscopy (81000) |
$10.80 |
$18 |
2.7× |
| Urinalysis, non-automated, without microscopy (81002) |
$9 |
$15 |
2.6× |
| PSA, total (84153) |
$60.60 |
$101 |
3.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$52.20 |
$87 |
3.1× |
| CBC with automated differential (85025) |
$25.80 |
$43 |
3.3× |
| CBC, automated (85027) |
$20.40 |
$34 |
3.2× |
| Prothrombin time (PT) (85610) |
$13.20 |
$22 |
3.1× |
| Partial thromboplastin time (PTT) (85730) |
$19.80 |
$33 |
3.3× |
| Psychotherapy, 30 minutes (90832) |
$88.46 |
$147.43 |
0.6× |
| Psychotherapy, 45 minutes (90834) |
$117.51 |
$195.85 |
0.8× |
| Psychotherapy, 60 minutes (90837) |
$183.64 |
$306.06 |
1.2× |
| Family psychotherapy, without patient (50 min) (90846) |
$125.20 |
$208.66 |
0.8× |
| Family psychotherapy, with patient (50 min) (90847) |
$131.19 |
$218.65 |
0.9× |
| Electrocardiogram (ECG), complete (93000) |
$17.40 |
$29 |
0.3× |
| Sleep study (attended polysomnography) (95810) |
$751.20 |
$1,252 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$40.20 |
$67 |
1.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$136.80 |
$228 |
1.2× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$205.80 |
$343 |
1.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$271.20 |
$452 |
2.4× |
| Office consultation (low complexity, ~30 min) (99243) |
$139.20 |
$232 |
1.2× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$199.20 |
$332 |
1.7× |
| Preventive visit, new patient (age 18–39) (99385) |
$159.60 |
$266 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$184.20 |
$307 |
— |