| Breast lesion removal (open) (19120) |
$4,887.57 |
— |
1.0× |
| Knee arthroscopy with meniscectomy (29881) |
$4,084.39 |
— |
1.0× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$7,389.63 |
— |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,132.18 |
— |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,132.18 |
— |
1.0× |
| Diagnostic colonoscopy (45378) |
$1,160.85 |
— |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,493.75 |
— |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,493.75 |
— |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,493.75 |
— |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$7,546.53 |
— |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$4,469.36 |
— |
1.0× |
| Laparoscopic radical prostatectomy (55866) |
$13,269.05 |
— |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,104.07 |
— |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,104.07 |
— |
1.0× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$686.55 |
— |
1.0× |
| Cataract removal with lens insertion (66984) |
$2,880.82 |
— |
1.0× |
| CT head/brain without contrast (70450) |
$130.50 |
$2,139 |
1.0× |
| MRI brain without contrast (70551) |
$297.84 |
$4,863 |
1.0× |
| MRI brain with contrast (70552) |
$435.49 |
$7,184 |
1.0× |
| MRI brain without and with contrast (70553) |
$435.49 |
$7,184 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$130.50 |
$1,176 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$297.84 |
$4,863 |
1.0× |
| CT pelvis with contrast (72193) |
$218.95 |
$3,581 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$297.84 |
$4,863 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$435.49 |
$7,184 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$130.50 |
$2,044 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$130.50 |
$1,871 |
1.0× |
| Ultrasound, transvaginal (76830) |
$130.50 |
$1,871 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
— |
$850 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$1,055 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$1,087 |
— |
| Basic metabolic panel (80048) |
— |
$401 |
— |
| Comprehensive metabolic panel (80053) |
— |
$718 |
— |
| Lipid panel (80061) |
— |
$517 |
— |
| Renal function panel (80069) |
— |
$554 |
— |
| Hepatic function panel (80076) |
— |
$531 |
— |
| PSA, total (84153) |
— |
$501 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$501 |
— |
| CBC with automated differential (85025) |
— |
$382 |
— |
| Prothrombin time (PT) (85610) |
— |
$411 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$732 |
— |
| Psychotherapy, 30 minutes (90832) |
$221.56 |
— |
1.0× |
| Psychotherapy, 45 minutes (90834) |
$221.56 |
— |
1.0× |
| Psychotherapy, 60 minutes (90837) |
$221.56 |
— |
1.0× |
| Family psychotherapy, without patient (50 min) (90846) |
$221.56 |
— |
1.0× |
| Family psychotherapy, with patient (50 min) (90847) |
$221.56 |
— |
1.0× |
| Group psychotherapy (90853) |
$126.81 |
— |
1.0× |
| Left heart catheterization (93452) |
$4,046.85 |
$16,450 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$1,071.95 |
$13,441 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$370 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$711 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$941 |
— |