| Shoulder arthroscopy with decompression (29826) |
$358.12 |
$477.50 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,279.50 |
$1,706 |
0.4× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$293.25 |
$391 |
0.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,007.62 |
$1,343.50 |
1.1× |
| Diagnostic colonoscopy (45378) |
$733.12 |
$977.50 |
0.7× |
| Colonoscopy with biopsy (45380) |
$892.12 |
$1,189.50 |
0.7× |
| Colonoscopy with lesion removal (45385) |
$977.25 |
$1,303 |
0.8× |
| Colonoscopy with endoscopic ultrasound (45391) |
$598.50 |
$798 |
0.5× |
Laparoscopic gallbladder removal (47562)
likely a partial charge — not the full procedure |
$1,537.88 |
$2,050.50 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$1,332.75 |
$1,777 |
0.4× |
Laparoscopic radical prostatectomy (55866)
likely a partial charge — not the full procedure |
$2,585.25 |
$3,447 |
0.2× |
| Obstetric care, vaginal delivery (global) (59400) |
$5,754.75 |
$7,673 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$6,068.25 |
$8,091 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,189.88 |
$1,586.50 |
1.3× |
| CT head/brain without contrast (70450) |
$292.50 |
$390 |
2.7× |
| MRI brain without contrast (70551) |
$537 |
$716 |
2.1× |
| MRI brain with contrast (70552) |
$1,332 |
$1,776 |
3.6× |
| MRI brain without and with contrast (70553) |
$1,662.15 |
$2,216.20 |
4.5× |
| X-ray lower spine, 4+ views (72110) |
$274.50 |
$366 |
2.5× |
| MRI lumbar spine without contrast (72148) |
$526.50 |
$702 |
2.1× |
| CT pelvis with contrast (72193) |
$1,040.25 |
$1,387 |
5.6× |
| MRI lower-extremity joint without contrast (73721) |
$906 |
$1,208 |
3.6× |
| CT abdomen and pelvis with contrast (74177) |
$827.25 |
$1,103 |
2.2× |
| Ultrasound, abdomen complete (76700) |
$314.25 |
$419 |
2.8× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$343.50 |
$458 |
3.1× |
| Ultrasound, transvaginal (76830) |
$324 |
$432 |
2.9× |
| Mammography, one breast (diagnostic) (77065) |
$243 |
$324 |
2.8× |
| Mammography, both breasts (diagnostic) (77066) |
$325.50 |
$434 |
2.9× |
| Mammography, screening (bilateral) (77067) |
$255.75 |
$341 |
2.8× |
| Basic metabolic panel (80048) |
$69.75 |
$93 |
8.2× |
| Comprehensive metabolic panel (80053) |
$96.75 |
$129 |
9.2× |
| Obstetric panel (80055) |
$177 |
$236 |
3.7× |
| Lipid panel (80061) |
$55.88 |
$74.50 |
4.2× |
| Renal function panel (80069) |
$117.75 |
$157 |
13.6× |
| Hepatic function panel (80076) |
$101.25 |
$135 |
12.4× |
| Urinalysis, non-automated, with microscopy (81000) |
$10.50 |
$14 |
2.6× |
| Urinalysis, non-automated, without microscopy (81002) |
$23.25 |
$31 |
6.7× |
| PSA, total (84153) |
$66.38 |
$88.50 |
3.6× |
| Thyroid stimulating hormone (TSH) (84443) |
$70.88 |
$94.50 |
4.2× |
| CBC with automated differential (85025) |
$51 |
$68 |
6.6× |
| CBC, automated (85027) |
$42.75 |
$57 |
6.6× |
| Prothrombin time (PT) (85610) |
$34.50 |
$46 |
8.0× |
| Partial thromboplastin time (PTT) (85730) |
$27.75 |
$37 |
4.6× |
| Electrocardiogram (ECG), complete (93000) |
$42 |
$56 |
0.7× |
| Left heart catheterization (93452) |
$604.50 |
$806 |
0.2× |
| Sleep study (attended polysomnography) (95810) |
$1,922.25 |
$2,563 |
2.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$97.50 |
$130 |
3.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$237 |
$316 |
1.7× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$329.25 |
$439 |
2.3× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$441 |
$588 |
3.1× |
| Office consultation (low complexity, ~30 min) (99243) |
$212.25 |
$283 |
1.5× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$231 |
$308 |
1.6× |
| Preventive visit, new patient (age 18–39) (99385) |
$309.75 |
$413 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$360.75 |
$481 |
— |