| Breast lesion removal (open) (19120) |
$3,914 |
$10,344.50 |
1.0× |
| Knee arthroscopy with meniscectomy (29881) |
$3,270 |
$17,376.80 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$906 |
$4,230.16 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$906 |
$8,403.58 |
1.0× |
| Diagnostic colonoscopy (45378) |
$929 |
$4,739.21 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,196 |
$7,167.16 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,196 |
$5,202.85 |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,196 |
$4,898.95 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,043 |
$17,251.60 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,579 |
$28,298.30 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$884 |
$3,172.95 |
1.0× |
| CT head/brain without contrast (70450) |
$104 |
$2,923.91 |
1.0× |
| MRI brain without contrast (70551) |
$238 |
$4,956.44 |
1.0× |
| MRI brain with contrast (70552) |
$348 |
$2,819 |
1.0× |
| MRI brain without and with contrast (70553) |
$348 |
$4,956.44 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$104 |
$930.05 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$238 |
$4,339.89 |
1.0× |
| CT pelvis with contrast (72193) |
$175 |
$3,513.29 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$238 |
$4,282.41 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$348 |
$6,331.66 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$104 |
$1,618.71 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$104 |
$1,549.74 |
1.0× |
| Ultrasound, transvaginal (76830) |
$104 |
$1,032.92 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$81 |
$641.32 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$104 |
$788.98 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$86 |
$616.55 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$352.17 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$403.37 |
0.9× |
| Lipid panel (80061) |
$13 |
$321.86 |
1.0× |
| Renal function panel (80069) |
$8 |
$365.75 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$288.42 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$29.26 |
0.9× |
| PSA, total (84153) |
$18 |
$96.09 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$87.78 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$156.75 |
0.9× |
| CBC, automated (85027) |
$6 |
$118.09 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$93.01 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$112.86 |
1.0× |
| Left heart catheterization (93452) |
$3,240 |
$14,052 |
1.0× |