| Breast lesion removal (open) (19120) |
— |
$250 |
— |
| Shoulder arthroscopy with decompression (29826) |
$199.80 |
$444 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$199.80 |
$444 |
0.1× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
— |
$583 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$112.50 |
$250 |
0.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$125.10 |
$278 |
0.1× |
| Diagnostic colonoscopy (45378) |
$967.05 |
$2,149 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,217.70 |
$2,706 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,260.90 |
$2,802 |
1.1× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$419.40 |
$932 |
0.1× |
| Inguinal hernia repair (age 5+) (49505) |
$9,512.55 |
$21,139 |
2.7× |
| Obstetric care, vaginal delivery (global) (59400) |
$2,434.95 |
$5,411 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$2,758.95 |
$6,131 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$2,178.45 |
$4,841 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$383.40 |
$852 |
0.4× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$872.55 |
$1,939 |
1.6× |
| CT head/brain without contrast (70450) |
$247.50 |
$550 |
2.4× |
| MRI brain without contrast (70551) |
$551.92 |
$1,226.50 |
2.3× |
| MRI brain with contrast (70552) |
$907.20 |
$2,016 |
2.6× |
| MRI brain without and with contrast (70553) |
$984.15 |
$2,187 |
2.8× |
| X-ray lower spine, 4+ views (72110) |
$173.48 |
$385.50 |
1.7× |
| MRI lumbar spine without contrast (72148) |
$551.92 |
$1,226.50 |
2.3× |
| CT pelvis with contrast (72193) |
$414 |
$920 |
2.4× |
| MRI lower-extremity joint without contrast (73721) |
$551.92 |
$1,226.50 |
2.3× |
| CT abdomen and pelvis with contrast (74177) |
$866.02 |
$1,924.50 |
2.5× |
| Ultrasound, abdomen complete (76700) |
$247.50 |
$550 |
2.4× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$247.50 |
$550 |
2.4× |
| Ultrasound, transvaginal (76830) |
$247.50 |
$550 |
2.4× |
| Mammography, one breast (diagnostic) (77065) |
$181.35 |
$403 |
2.1× |
| Mammography, both breasts (diagnostic) (77066) |
$229.72 |
$510.50 |
2.1× |
| Mammography, screening (bilateral) (77067) |
$184.72 |
$410.50 |
2.0× |
| Basic metabolic panel (80048) |
$19.35 |
$43 |
2.3× |
| Comprehensive metabolic panel (80053) |
$23.85 |
$53 |
2.3× |
| Lipid panel (80061) |
$30.15 |
$67 |
2.3× |
| Renal function panel (80069) |
$19.80 |
$44 |
2.3× |
| Hepatic function panel (80076) |
$18.45 |
$41 |
2.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$19.80 |
$44 |
5.7× |
| PSA, total (84153) |
$84.60 |
$188 |
4.6× |
| Thyroid stimulating hormone (TSH) (84443) |
$37.80 |
$84 |
2.2× |
| CBC with automated differential (85025) |
$17.55 |
$39 |
2.3× |
| CBC, automated (85027) |
$14.85 |
$33 |
2.3× |
| Prothrombin time (PT) (85610) |
$36.45 |
$81 |
8.5× |
| Partial thromboplastin time (PTT) (85730) |
$30.15 |
$67 |
5.0× |
| Psychotherapy, 30 minutes (90832) |
$97.42 |
$216.50 |
0.5× |
| Psychotherapy, 45 minutes (90834) |
$133.42 |
$296.50 |
0.8× |
| Psychotherapy, 60 minutes (90837) |
$206.55 |
$459 |
1.2× |
| Family psychotherapy, without patient (50 min) (90846) |
$131.40 |
$292 |
0.7× |
| Family psychotherapy, with patient (50 min) (90847) |
$106.65 |
$237 |
0.6× |
| Sleep study (attended polysomnography) (95810) |
$1,018.80 |
$2,264 |
1.2× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$42.75 |
$95 |
1.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$151.20 |
$336 |
1.1× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$200.25 |
$445 |
1.5× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$225 |
$500 |
1.7× |
| Office consultation (low complexity, ~30 min) (99243) |
$163.80 |
$364 |
1.2× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$230.85 |
$513 |
1.7× |
| Preventive visit, new patient (age 18–39) (99385) |
$175.50 |
$390 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$206.55 |
$459 |
— |