| Upper GI endoscopy (EGD), diagnostic (43235) |
$211.20 |
$528 |
0.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$180.40 |
$451 |
0.2× |
| Diagnostic colonoscopy (45378) |
$263.60 |
$659 |
0.3× |
| Colonoscopy with biopsy (45380) |
$314.80 |
$787 |
0.3× |
| Colonoscopy with lesion removal (45385) |
$374 |
$935 |
0.3× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$793.60 |
$1,984 |
0.1× |
| Inguinal hernia repair (age 5+) (49505) |
$625.20 |
$1,563 |
0.2× |
| Cataract removal with lens insertion (66984) |
$755.20 |
$1,888 |
0.4× |
| CT head/brain without contrast (70450) |
$407.20 |
$1,018 |
4.3× |
| MRI brain without contrast (70551) |
$450.40 |
$1,126 |
2.1× |
| MRI brain with contrast (70552) |
$651.20 |
$1,628 |
2.1× |
| MRI brain without and with contrast (70553) |
$752.80 |
$1,882 |
2.4× |
| X-ray lower spine, 4+ views (72110) |
$125.20 |
$313 |
1.3× |
| MRI lumbar spine without contrast (72148) |
$450.40 |
$1,126 |
2.1× |
| CT pelvis with contrast (72193) |
$801.60 |
$2,004 |
5.0× |
| MRI lower-extremity joint without contrast (73721) |
$450.40 |
$1,126 |
2.1× |
| CT abdomen and pelvis with contrast (74177) |
$1,256 |
$3,140 |
4.0× |
| Ultrasound, abdomen complete (76700) |
$205.60 |
$514 |
2.2× |
| Ultrasound, transvaginal (76830) |
$205.80 |
$514.50 |
2.2× |
| Mammography, one breast (diagnostic) (77065) |
$158.40 |
$396 |
1.8× |
| Mammography, both breasts (diagnostic) (77066) |
$199.60 |
$499 |
1.8× |
| Mammography, screening (bilateral) (77067) |
$168.80 |
$422 |
1.9× |
| Basic metabolic panel (80048) |
$31.20 |
$78 |
3.7× |
| Comprehensive metabolic panel (80053) |
$38.80 |
$97 |
3.7× |
| Lipid panel (80061) |
$44.20 |
$110.50 |
3.3× |
| Renal function panel (80069) |
$32 |
$80 |
3.7× |
| Hepatic function panel (80076) |
$30.40 |
$76 |
3.7× |
| Urinalysis, non-automated, without microscopy (81002) |
$6.40 |
$16 |
1.8× |
| PSA, total (84153) |
$67.60 |
$169 |
3.7× |
| Thyroid stimulating hormone (TSH) (84443) |
$61.60 |
$154 |
3.7× |
| CBC with automated differential (85025) |
$28.80 |
$72 |
3.7× |
| Prothrombin time (PT) (85610) |
$10 |
$25 |
2.3× |
| Partial thromboplastin time (PTT) (85730) |
$22.40 |
$56 |
3.7× |
| Electrocardiogram (ECG), complete (93000) |
$34.20 |
$85.50 |
0.6× |
| Left heart catheterization (93452) |
$889.20 |
$2,223 |
0.3× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$33.60 |
$84 |
1.2× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$95.60 |
$239 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$131.60 |
$329 |
1.1× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$168 |
$420 |
1.4× |
| Office consultation (low complexity, ~30 min) (99243) |
$91.60 |
$229 |
0.8× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$137.20 |
$343 |
1.1× |
| Preventive visit, new patient (age 18–39) (99385) |
$69 |
$172.50 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$74 |
$185 |
— |