Breast lesion removal (open) (19120) range across 2 matching MRF lines |
$4,175 |
$33,551.25–$33,551.30 |
1.0× |
Knee arthroscopy with meniscectomy (29881) range across 2 matching MRF lines |
$3,489 |
$38,338.30–$38,338.32 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$967 |
$5,033.12 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$967 |
$5,033.12 |
1.0× |
| Diagnostic colonoscopy (45378) |
$991 |
$4,982.80 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,276 |
$6,411.72 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,276 |
$6,411.72 |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,276 |
$6,411.72 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,446 |
$49,102.40 |
1.0× |
Inguinal hernia repair (age 5+) (49505) range across 2 matching MRF lines |
$3,818 |
$35,552.70–$35,552.72 |
1.0× |
| CT head/brain without contrast (70450) |
$111 |
$3,683 |
1.0× |
| MRI brain without contrast (70551) |
$254 |
$4,603 |
1.0× |
| MRI brain with contrast (70552) |
$372 |
$5,260 |
1.0× |
| MRI brain without and with contrast (70553) |
$372 |
$5,916 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$111 |
$1,182 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$254 |
$4,603 |
1.0× |
| CT pelvis with contrast (72193) |
$187 |
$4,471 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$254 |
$4,603 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$372 |
$6,576 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$111 |
$2,631 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$111 |
$1,066 |
1.0× |
| Ultrasound, transvaginal (76830) |
$111 |
$1,264 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$87 |
$657 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$111 |
$908 |
1.0× |
| Mammography, screening (bilateral) (77067) |
$92 |
$618 |
1.0× |
| Basic metabolic panel (80048) |
$8 |
$317 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$344 |
0.9× |
| Lipid panel (80061) |
$13 |
$226 |
1.0× |
| Renal function panel (80069) |
$8 |
$238 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$618 |
1.0× |
| Urinalysis, non-automated, with microscopy (81000) |
$4 |
$99 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$79 |
0.9× |
| PSA, total (84153) |
$18 |
$226 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$212 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$160 |
0.9× |
| CBC, automated (85027) |
$6 |
$160 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$118 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$238 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$915 |
$6,837 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$29 |
$261 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$709.85 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$709.85 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$709.85 |
— |