| Breast lesion removal (open) (19120) |
$3,914 |
$13,005 |
1.0× |
| Shoulder arthroscopy with decompression (29826) |
— |
$9,627.14 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$3,270 |
$14,741.70 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$906 |
$6,390.78 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$906 |
$8,408.81 |
1.0× |
| Diagnostic colonoscopy (45378) |
$929 |
$8,302.33 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,196 |
$8,164.91 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,196 |
$9,930.84 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,043 |
$19,156.10 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,579 |
$17,385 |
1.0× |
| Laparoscopic radical prostatectomy (55866) |
$10,625 |
$34,046 |
1.0× |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$263.42 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$884 |
$7,381.82 |
1.0× |
| CT head/brain without contrast (70450) |
$104 |
$3,383.04 |
1.0× |
| MRI brain without contrast (70551) |
$238 |
$5,405.53 |
1.0× |
| MRI brain with contrast (70552) |
$348 |
$2,852.01 |
1.0× |
| MRI brain without and with contrast (70553) |
$348 |
$7,681.64 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$104 |
$779.54 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$238 |
$5,909.12 |
1.0× |
| CT pelvis with contrast (72193) |
$175 |
$3,807.22 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$238 |
$4,810.83 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$348 |
$9,401.50 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$104 |
$1,626.73 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$104 |
$1,517.35 |
1.0× |
| Ultrasound, transvaginal (76830) |
$104 |
$1,105.92 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$81 |
$612.88 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$104 |
$765.33 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$86 |
$326.97 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$410.90 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$393.72 |
0.9× |
| Lipid panel (80061) |
$13 |
$312.32 |
1.0× |
| Renal function panel (80069) |
$8 |
$304.33 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$327.67 |
1.0× |
| Urinalysis, non-automated, with microscopy (81000) |
$4 |
$69.75 |
1.0× |
| PSA, total (84153) |
$18 |
$325.38 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$221.13 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$183.54 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$35.77 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$82.39 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$28 |
$260.97 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$778.41 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$982.74 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$1,134.24 |
— |