| Breast lesion removal (open) (19120) |
$625 |
$625 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$578 |
$578 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$935 |
$935 |
1.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,507.44 |
$1,507.44 |
1.8× |
| Diagnostic colonoscopy (45378) |
$1,726.56 |
$1,726.56 |
2.0× |
| Colonoscopy with biopsy (45380) |
$1,430 |
$1,430 |
1.3× |
| Colonoscopy with lesion removal (45385) |
$1,668.70 |
$1,668.70 |
1.5× |
| Laparoscopic gallbladder removal (47562) |
$5,510 |
$5,510 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,355 |
$3,355 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$850 |
$850 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$420 |
$420 |
0.5× |
| CT head/brain without contrast (70450) |
$632.54 |
$632.54 |
6.6× |
| MRI brain without contrast (70551) |
$727.49 |
$727.49 |
3.3× |
| MRI brain with contrast (70552) |
$727.49 |
$727.49 |
2.3× |
| MRI brain without and with contrast (70553) |
$727.49 |
$727.49 |
2.3× |
| X-ray lower spine, 4+ views (72110) |
$438.90 |
$438.90 |
4.6× |
| MRI lumbar spine without contrast (72148) |
$727.49 |
$727.49 |
3.3× |
| CT pelvis with contrast (72193) |
$778.85 |
$778.85 |
4.8× |
| MRI lower-extremity joint without contrast (73721) |
$687.20 |
$687.20 |
3.1× |
| CT abdomen and pelvis with contrast (74177) |
$779.16 |
$779.16 |
2.4× |
| Ultrasound, abdomen complete (76700) |
$457.05 |
$457.05 |
4.8× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$356.40 |
$356.40 |
3.7× |
| Ultrasound, transvaginal (76830) |
$246.40 |
$246.40 |
2.6× |
| Basic metabolic panel (80048) |
$50.41 |
$50.41 |
6.0× |
| Comprehensive metabolic panel (80053) |
$61.54 |
$61.54 |
5.8× |
| Lipid panel (80061) |
$56.43 |
$56.43 |
4.2× |
| Renal function panel (80069) |
$68.75 |
$68.75 |
7.9× |
| Hepatic function panel (80076) |
$42.98 |
$42.98 |
5.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$13.54 |
$13.54 |
3.9× |
| PSA, total (84153) |
$138.04 |
$138.04 |
7.5× |
| Thyroid stimulating hormone (TSH) (84443) |
$57.46 |
$57.46 |
3.4× |
| CBC with automated differential (85025) |
$40.61 |
$40.61 |
5.2× |
| CBC, automated (85027) |
$37.32 |
$37.32 |
5.8× |
| Prothrombin time (PT) (85610) |
$21.01 |
$21.01 |
4.9× |
| Partial thromboplastin time (PTT) (85730) |
$38.68 |
$38.68 |
6.4× |
| Sleep study (attended polysomnography) (95810) |
$1,764 |
$1,764 |
2.2× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$64.68 |
$64.68 |
2.2× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$126 |
$126 |
1.0× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$194 |
$194 |
1.6× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$200.33 |
$200.33 |
1.6× |
| Preventive visit, new patient (age 40–64) (99386) |
$150 |
$150 |
— |