| Breast lesion removal (open) (19120) |
$573.04 |
$1,102 |
0.2× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$415.48 |
$799 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$170.04 |
$327 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$191.88 |
$369 |
0.2× |
| Diagnostic colonoscopy (45378) |
$255.32 |
$491 |
0.3× |
| Colonoscopy with biopsy (45380) |
$277.68 |
$534 |
0.3× |
| Colonoscopy with lesion removal (45385) |
$352.04 |
$677 |
0.3× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$903.76 |
$1,738 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$716.56 |
$1,378 |
0.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$926.12 |
$1,781 |
1.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$926.12 |
$1,781 |
1.1× |
| Cataract removal with lens insertion (66984) |
$2,865.20 |
$5,510 |
1.4× |
| CT head/brain without contrast (70450) |
$444.08 |
$854 |
4.7× |
| MRI brain without contrast (70551) |
$887.12 |
$1,706 |
4.1× |
| MRI brain with contrast (70552) |
$1,482.52 |
$2,851 |
4.7× |
| MRI brain without and with contrast (70553) |
$1,668.16 |
$3,208 |
5.3× |
| X-ray lower spine, 4+ views (72110) |
$257.92 |
$496 |
2.7× |
| MRI lumbar spine without contrast (72148) |
$887.12 |
$1,706 |
4.1× |
| CT pelvis with contrast (72193) |
$791.96 |
$1,523 |
5.0× |
| MRI lower-extremity joint without contrast (73721) |
$926.64 |
$1,782 |
4.3× |
| CT abdomen and pelvis with contrast (74177) |
$1,575.60 |
$3,030 |
5.0× |
| Ultrasound, abdomen complete (76700) |
$222.04 |
$427 |
2.3× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$222.04 |
$427 |
2.3× |
| Ultrasound, transvaginal (76830) |
$222.04 |
$427 |
2.3× |
| Mammography, one breast (diagnostic) (77065) |
$227.76 |
$438 |
2.6× |
| Mammography, both breasts (diagnostic) (77066) |
$288.08 |
$554 |
2.6× |
| Mammography, screening (bilateral) (77067) |
$231.40 |
$445 |
2.5× |
| Basic metabolic panel (80048) |
$26.52 |
$51 |
3.1× |
| Comprehensive metabolic panel (80053) |
$32.76 |
$63 |
3.1× |
| Lipid panel (80061) |
$28.60 |
$55 |
2.1× |
| Renal function panel (80069) |
$27.04 |
$52 |
3.1× |
| Hepatic function panel (80076) |
$25.48 |
$49 |
3.1× |
| PSA, total (84153) |
$57.20 |
$110 |
3.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$52.52 |
$101 |
3.1× |
| CBC with automated differential (85025) |
$24.44 |
$47 |
3.1× |
| CBC, automated (85027) |
$20.28 |
$39 |
3.1× |
| Prothrombin time (PT) (85610) |
$13.52 |
$26 |
3.2× |
| Partial thromboplastin time (PTT) (85730) |
$18.72 |
$36 |
3.1× |
| Sleep study (attended polysomnography) (95810) |
$1,368.64 |
$2,632 |
1.8× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$70.20 |
$135 |
2.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$152.10 |
$292.50 |
1.3× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$209.04 |
$402 |
1.7× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$270.40 |
$520 |
2.2× |