| Breast lesion removal (open) (19120) |
$4,204.73 |
— |
1.2× |
| Knee arthroscopy with meniscectomy (29881) |
$3,562.74 |
— |
1.2× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$6,495.68 |
— |
1.2× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,029.48 |
$1,404 |
1.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,029.48 |
— |
1.2× |
| Diagnostic colonoscopy (45378) |
$1,001.10 |
$630 |
1.2× |
| Colonoscopy with biopsy (45380) |
$1,294.69 |
— |
1.2× |
| Colonoscopy with lesion removal (45385) |
$1,294.69 |
— |
1.2× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,294.69 |
— |
1.2× |
| Laparoscopic gallbladder removal (47562) |
$6,406.40 |
— |
1.2× |
| Inguinal hernia repair (age 5+) (49505) |
$3,875.08 |
— |
1.2× |
| Laparoscopic radical prostatectomy (55866) |
$11,432.02 |
— |
1.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$977.58 |
— |
1.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$977.58 |
$2,883 |
1.2× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$602.39 |
— |
1.2× |
| Cataract removal with lens insertion (66984) |
$2,504.35 |
$5,570 |
1.2× |
| CT head/brain without contrast (70450) |
$116.77 |
$929 |
1.2× |
| MRI brain without contrast (70551) |
$265.42 |
$1,663 |
1.2× |
| MRI brain with contrast (70552) |
$392.15 |
$1,807.50 |
1.2× |
| MRI brain without and with contrast (70553) |
$392.15 |
$2,547 |
1.2× |
| X-ray lower spine, 4+ views (72110) |
$116.77 |
$358 |
1.2× |
| MRI lumbar spine without contrast (72148) |
$265.42 |
$1,663 |
1.2× |
| CT pelvis with contrast (72193) |
$195.48 |
$1,414 |
1.2× |
| MRI lower-extremity joint without contrast (73721) |
$265.42 |
$1,663 |
1.2× |
| CT abdomen and pelvis with contrast (74177) |
$392.15 |
$1,248 |
1.2× |
| Ultrasound, abdomen complete (76700) |
$116.77 |
$463 |
1.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$116.77 |
— |
1.2× |
| Ultrasound, transvaginal (76830) |
$116.77 |
$809 |
1.2× |
| Basic metabolic panel (80048) |
$10.15 |
$64 |
1.2× |
| Comprehensive metabolic panel (80053) |
$12.67 |
$80 |
1.2× |
| Obstetric panel (80055) |
$57.37 |
— |
1.2× |
| Lipid panel (80061) |
$16.07 |
$90 |
1.2× |
| Renal function panel (80069) |
$10.42 |
$65 |
1.2× |
| Hepatic function panel (80076) |
$9.80 |
$62 |
1.2× |
| Urinalysis, non-automated, with microscopy (81000) |
$4.82 |
— |
1.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.18 |
— |
1.2× |
| PSA, total (84153) |
$22.07 |
$138 |
1.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$20.16 |
$125 |
1.2× |
| CBC with automated differential (85025) |
$9.32 |
$59 |
1.2× |
| CBC, automated (85027) |
$7.76 |
$48 |
1.2× |
| Prothrombin time (PT) (85610) |
$5.15 |
$30 |
1.2× |
| Partial thromboplastin time (PTT) (85730) |
$7.21 |
$45 |
1.2× |
| Psychotherapy, 30 minutes (90832) |
$176.42 |
— |
1.1× |
| Psychotherapy, 45 minutes (90834) |
$176.42 |
— |
1.1× |
| Psychotherapy, 60 minutes (90837) |
$176.42 |
— |
1.1× |
| Family psychotherapy, without patient (50 min) (90846) |
$176.42 |
— |
1.1× |
| Family psychotherapy, with patient (50 min) (90847) |
$176.42 |
— |
1.1× |
| Group psychotherapy (90853) |
$101.57 |
— |
1.1× |
| Left heart catheterization (93452) |
$3,531.77 |
— |
1.2× |
| Sleep study (attended polysomnography) (95810) |
$1,117.14 |
$3,963.50 |
1.4× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$185.50 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$338 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$416 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$574 |
— |