| Breast lesion removal (open) (19120) |
$4,070 |
$4,070 |
1.1× |
| Shoulder arthroscopy with decompression (29826) |
$3,908.52 |
$3,908.52 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$5,562 |
$5,562 |
1.7× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$5,347.50 |
$5,347.50 |
0.9× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,288.58 |
$1,288.58 |
1.4× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,097.25 |
$1,097.25 |
1.2× |
| Diagnostic colonoscopy (45378) |
$1,408.75 |
$1,408.75 |
1.5× |
| Colonoscopy with biopsy (45380) |
$2,150 |
$2,150 |
1.8× |
| Colonoscopy with lesion removal (45385) |
$1,940 |
$1,940 |
1.6× |
| Laparoscopic gallbladder removal (47562) |
$8,271 |
$8,271 |
1.4× |
| Inguinal hernia repair (age 5+) (49505) |
$4,031 |
$4,031 |
1.1× |
| Laparoscopic radical prostatectomy (55866) |
$7,725 |
$7,725 |
0.7× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$800 |
$800 |
0.9× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$2,033.50 |
$2,033.50 |
2.3× |
| Cataract removal with lens insertion (66984) |
$1,765 |
$1,765 |
0.8× |
| CT head/brain without contrast (70450) |
$737 |
$737 |
7.1× |
| MRI brain without contrast (70551) |
$1,139.50 |
$1,139.50 |
4.8× |
| MRI brain with contrast (70552) |
$1,398 |
$1,398 |
4.1× |
| MRI brain without and with contrast (70553) |
$2,140 |
$2,140 |
6.2× |
| X-ray lower spine, 4+ views (72110) |
$290 |
$290 |
2.8× |
| MRI lumbar spine without contrast (72148) |
$1,405 |
$1,405 |
6.0× |
| CT pelvis with contrast (72193) |
$899 |
$899 |
5.2× |
| MRI lower-extremity joint without contrast (73721) |
$1,404 |
$1,404 |
6.0× |
| CT abdomen and pelvis with contrast (74177) |
$1,765 |
$1,765 |
5.1× |
| Ultrasound, abdomen complete (76700) |
$475 |
$475 |
4.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$380 |
$380 |
3.7× |
| Ultrasound, transvaginal (76830) |
$426.25 |
$426.25 |
4.1× |
| Mammography, one breast (diagnostic) (77065) |
$309 |
$309 |
3.6× |
| Mammography, both breasts (diagnostic) (77066) |
$374.50 |
$374.50 |
3.4× |
| Mammography, screening (bilateral) (77067) |
$328 |
$328 |
3.6× |
| Basic metabolic panel (80048) |
$63 |
$63 |
7.4× |
| Comprehensive metabolic panel (80053) |
$84 |
$84 |
8.0× |
| Lipid panel (80061) |
$73.78 |
$73.78 |
5.5× |
| Renal function panel (80069) |
$41 |
$41 |
4.7× |
| Hepatic function panel (80076) |
$156 |
$156 |
19.1× |
| PSA, total (84153) |
$92 |
$92 |
5.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$85 |
$85 |
5.1× |
| CBC with automated differential (85025) |
$43 |
$43 |
5.5× |
| CBC, automated (85027) |
$30 |
$30 |
4.6× |
| Prothrombin time (PT) (85610) |
$46.20 |
$46.20 |
10.8× |
| Partial thromboplastin time (PTT) (85730) |
$96.30 |
$96.30 |
16.0× |
| Left heart catheterization (93452) |
$14,000 |
$14,000 |
4.4× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$89 |
$89 |
3.1× |