| Breast lesion removal (open) (19120) |
$474.09 |
$790.15 |
0.1× |
| Shoulder arthroscopy with decompression (29826) |
$192 |
$320 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$690 |
$1,150 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$339 |
$565 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$984 |
$1,640 |
1.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$984 |
$1,640 |
1.1× |
| Diagnostic colonoscopy (45378) |
$939.60 |
$1,566 |
1.1× |
| Colonoscopy with biopsy (45380) |
$1,239 |
$2,065 |
1.1× |
| Colonoscopy with lesion removal (45385) |
$1,239 |
$2,065 |
1.1× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$765 |
$1,275 |
0.1× |
| Inguinal hernia repair (age 5+) (49505) |
$594 |
$990 |
0.2× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$804.60 |
$1,341 |
1.5× |
| Cataract removal with lens insertion (66984) |
$1,672.80 |
$2,788 |
0.8× |
| CT head/brain without contrast (70450) |
$685.20 |
$1,142 |
6.8× |
| MRI brain without contrast (70551) |
$1,029 |
$1,715 |
4.5× |
| MRI brain with contrast (70552) |
$1,146 |
$1,910 |
3.4× |
| MRI brain without and with contrast (70553) |
$1,482 |
$2,470 |
4.4× |
| X-ray lower spine, 4+ views (72110) |
$213 |
$355 |
2.1× |
| MRI lumbar spine without contrast (72148) |
$1,029 |
$1,715 |
4.5× |
| CT pelvis with contrast (72193) |
$830.40 |
$1,384 |
4.9× |
| MRI lower-extremity joint without contrast (73721) |
$1,087.50 |
$1,812.50 |
4.7× |
| CT abdomen and pelvis with contrast (74177) |
$873.60 |
$1,456 |
2.6× |
| Ultrasound, abdomen complete (76700) |
$259.80 |
$433 |
2.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$216.04 |
$360.07 |
2.1× |
| Ultrasound, transvaginal (76830) |
$259.80 |
$433 |
2.6× |
| Mammography, one breast (diagnostic) (77065) |
$147.90 |
$246.50 |
1.7× |
| Mammography, both breasts (diagnostic) (77066) |
$224.40 |
$374 |
2.0× |
| Mammography, screening (bilateral) (77067) |
$152.70 |
$254.50 |
1.7× |
| Basic metabolic panel (80048) |
$17.28 |
$28.80 |
2.0× |
| Comprehensive metabolic panel (80053) |
$21.59 |
$35.98 |
2.0× |
| Obstetric panel (80055) |
$97.68 |
$162.80 |
2.0× |
| Lipid panel (80061) |
$46.20 |
$77 |
3.5× |
| Renal function panel (80069) |
$17.75 |
$29.58 |
2.0× |
| Hepatic function panel (80076) |
$31.20 |
$52 |
3.8× |
| Urinalysis, non-automated, without microscopy (81002) |
$5.22 |
$8.70 |
1.5× |
| PSA, total (84153) |
$63 |
$105 |
3.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$57.60 |
$96 |
3.4× |
| CBC with automated differential (85025) |
$31.20 |
$52 |
4.0× |
| CBC, automated (85027) |
$13.22 |
$22.03 |
2.0× |
| Prothrombin time (PT) (85610) |
$20.40 |
$34 |
4.8× |
| Partial thromboplastin time (PTT) (85730) |
$25.20 |
$42 |
4.2× |
| Psychotherapy, 30 minutes (90832) |
$96.20 |
$160.33 |
0.6× |
| Psychotherapy, 45 minutes (90834) |
$127.91 |
$213.18 |
0.7× |
| Psychotherapy, 60 minutes (90837) |
$191.86 |
$319.76 |
1.1× |
| Family psychotherapy, without patient (50 min) (90846) |
$155.32 |
$258.86 |
0.9× |
| Family psychotherapy, with patient (50 min) (90847) |
$160.69 |
$267.81 |
0.9× |
| Group psychotherapy (90853) |
$38.69 |
$64.49 |
0.4× |
| Electrocardiogram (ECG), complete (93000) |
$93 |
$155 |
1.6× |
| Sleep study (attended polysomnography) (95810) |
$463.50 |
$772.50 |
0.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$85.20 |
$142 |
2.9× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$163.91 |
$273.19 |
1.3× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$249.36 |
$415.60 |
1.9× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$312.78 |
$521.30 |
2.4× |
| Office consultation (low complexity, ~30 min) (99243) |
$185.41 |
$309.02 |
1.4× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$185.41 |
$309.02 |
1.4× |
| Preventive visit, new patient (age 18–39) (99385) |
$198.85 |
$331.41 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$231.09 |
$385.15 |
— |