| Breast lesion removal (open) (19120) |
$3,914 |
$12,431.40 |
1.0× |
| Shoulder arthroscopy with decompression (29826) |
— |
$7,770.07 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$3,270 |
$13,441.40 |
1.0× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$5,917 |
$11,641.50 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$906 |
$25,694.58 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$906 |
$5,477.45 |
1.0× |
| Diagnostic colonoscopy (45378) |
$929 |
$5,285.92 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,196 |
$7,047.14 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,196 |
$7,047.14 |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,196 |
$7,898.60 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,043 |
$14,701.30 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,579 |
$15,139.50 |
1.0× |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$3,600 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$884 |
$15,693.69 |
1.0× |
| CT head/brain without contrast (70450) |
$104 |
$2,778.84 |
1.0× |
| MRI brain without contrast (70551) |
$238 |
$3,883.42 |
1.0× |
| MRI brain with contrast (70552) |
$348 |
$3,830.75 |
1.0× |
| MRI brain without and with contrast (70553) |
$348 |
$4,473.91 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$104 |
$1,477.54 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$238 |
$3,610.90 |
1.0× |
| CT pelvis with contrast (72193) |
$175 |
$3,216.73 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$238 |
$1,897.36 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$348 |
$5,681.56 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$104 |
$898.70 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$104 |
$1,301 |
1.0× |
| Ultrasound, transvaginal (76830) |
$104 |
$728.57 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$81 |
$615.47 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$104 |
$768.57 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$86 |
$472.90 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$250.24 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$438.50 |
0.9× |
| Obstetric panel (80055) |
$47 |
$95.75 |
1.0× |
| Lipid panel (80061) |
$13 |
$312.16 |
1.0× |
| Renal function panel (80069) |
$8 |
$564.66 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$267.63 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$56.44 |
0.9× |
| PSA, total (84153) |
$18 |
$91.95 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$84 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$186 |
0.9× |
| CBC, automated (85027) |
$6 |
$116 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$207 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$244 |
1.0× |
| Left heart catheterization (93452) |
$3,240 |
$15,613.50 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$858 |
$6,565.24 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$28 |
$135.60 |
1.0× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$2,431.60 |
— |