| Breast lesion removal (open) (19120) |
$3,494 |
$19,824.10 |
1.0× |
| Shoulder arthroscopy with decompression (29826) |
— |
$14,246.68 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$2,920 |
$25,776.50 |
1.0× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$5,283 |
$23,655.50 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$809 |
$11,536.52 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$809 |
$11,536.52 |
1.0× |
| Diagnostic colonoscopy (45378) |
$830 |
$3,850.35 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,068 |
$4,971.45 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,068 |
$4,971.45 |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,068 |
$2,904.80 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$5,395 |
$20,614.80 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,195 |
$15,814.02 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$789 |
$10,657.58 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$789 |
$10,175.88 |
1.0× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$490 |
$2,128.58 |
1.0× |
| CT head/brain without contrast (70450) |
$93 |
$3,974.95 |
1.0× |
| MRI brain without contrast (70551) |
$212 |
$6,802.64 |
1.0× |
| MRI brain with contrast (70552) |
$311 |
$9,171.17 |
1.0× |
| MRI brain without and with contrast (70553) |
$311 |
$16,603.60 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$93 |
$2,294.20 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$212 |
$11,654 |
1.0× |
| CT pelvis with contrast (72193) |
$156 |
$5,919.87 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$212 |
$14,926.90 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$311 |
$13,054.20 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$93 |
$1,958.62 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$93 |
$2,009.63 |
1.0× |
| Ultrasound, transvaginal (76830) |
$93 |
$830.25 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$75 |
$762.40 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$96 |
$929.57 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$79 |
$444.05 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$899.99 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$940.03 |
0.9× |
| Lipid panel (80061) |
$13 |
$605.09 |
1.0× |
| Renal function panel (80069) |
$8 |
$1,143.52 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$730.30 |
1.0× |
| Urinalysis, non-automated, with microscopy (81000) |
$4 |
$219.05 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$117.64 |
0.9× |
| PSA, total (84153) |
$18 |
$306.41 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$896.10 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$256.60 |
0.9× |
| CBC, automated (85027) |
$6 |
$143.83 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$301.01 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$301.54 |
1.0× |
| Psychotherapy, 30 minutes (90832) |
$158 |
$528.70 |
1.0× |
| Psychotherapy, 45 minutes (90834) |
$158 |
$375.12 |
1.0× |
| Psychotherapy, 60 minutes (90837) |
$158 |
$335.48 |
1.0× |
| Family psychotherapy, without patient (50 min) (90846) |
$158 |
$282.03 |
1.0× |
| Family psychotherapy, with patient (50 min) (90847) |
$158 |
$625.20 |
1.0× |
| Group psychotherapy (90853) |
$90 |
$78.25 |
1.0× |
| Left heart catheterization (93452) |
$2,893 |
$20,196.50 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$766 |
$7,469.86 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$27 |
$229.38 |
0.9× |