| Breast lesion removal (open) (19120) |
$283.50 |
$567 |
0.1× |
| Shoulder arthroscopy with decompression (29826) |
$557.50 |
$1,115 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$525.50 |
$1,051 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$373.50 |
$747 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$208.50 |
$417 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$239.50 |
$479 |
0.3× |
| Diagnostic colonoscopy (45378) |
$270.50 |
$541 |
0.3× |
| Colonoscopy with biopsy (45380) |
$322 |
$644 |
0.3× |
| Colonoscopy with lesion removal (45385) |
$365.50 |
$731 |
0.3× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$493 |
$986 |
0.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$679.50 |
$1,359 |
0.8× |
| CT head/brain without contrast (70450) |
$601.50 |
$1,203 |
6.1× |
| MRI brain without contrast (70551) |
$656.50 |
$1,313 |
2.9× |
| MRI brain without and with contrast (70553) |
$656.50 |
$1,313 |
2.0× |
| X-ray lower spine, 4+ views (72110) |
$264 |
$528 |
2.7× |
| MRI lumbar spine without contrast (72148) |
$656.50 |
$1,313 |
2.9× |
| CT pelvis with contrast (72193) |
$601.50 |
$1,203 |
3.7× |
| MRI lower-extremity joint without contrast (73721) |
$656.50 |
$1,313 |
2.9× |
| CT abdomen and pelvis with contrast (74177) |
$601.50 |
$1,203 |
1.8× |
| Ultrasound, abdomen complete (76700) |
$534 |
$1,068 |
5.4× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$320.50 |
$641 |
3.3× |
| Ultrasound, transvaginal (76830) |
$373.75 |
$747.50 |
3.8× |
| Mammography, one breast (diagnostic) (77065) |
$170.50 |
$341 |
2.0× |
| Mammography, both breasts (diagnostic) (77066) |
$243.50 |
$487 |
2.2× |
| Mammography, screening (bilateral) (77067) |
$196.50 |
$393 |
2.2× |
| Basic metabolic panel (80048) |
$12.50 |
$25 |
1.5× |
| Comprehensive metabolic panel (80053) |
$15 |
$30 |
1.4× |
| Lipid panel (80061) |
$14.75 |
$29.50 |
1.1× |
| Renal function panel (80069) |
$12.50 |
$25 |
1.4× |
| Hepatic function panel (80076) |
$10.50 |
$21 |
1.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$3.50 |
$7 |
1.0× |
| PSA, total (84153) |
$26 |
$52 |
1.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$23.50 |
$47 |
1.4× |
| CBC with automated differential (85025) |
$11.50 |
$23 |
1.5× |
| CBC, automated (85027) |
$10 |
$20 |
1.5× |
| Prothrombin time (PT) (85610) |
$61.50 |
$123 |
14.3× |
| Partial thromboplastin time (PTT) (85730) |
$71 |
$142 |
11.8× |
| Psychotherapy, 60 minutes (90837) |
$71.25 |
$142.50 |
0.4× |
| Sleep study (attended polysomnography) (95810) |
$2,147.50 |
$4,295 |
2.7× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$67.50 |
$135 |
2.3× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$87.50 |
$175 |
0.7× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$92.50 |
$185 |
0.7× |