| Breast lesion removal (open) (19120) |
$4,258 |
$11,528.20 |
1.0× |
| Shoulder arthroscopy with decompression (29826) |
— |
$5,925.99 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$3,559 |
$12,969.10 |
1.0× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$6,439 |
$12,156.70 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$986 |
$4,885.53 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$986 |
$4,885.53 |
1.0× |
| Diagnostic colonoscopy (45378) |
$1,011 |
$4,750.83 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,301 |
$6,144.07 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,301 |
$6,144.07 |
1.0× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,301 |
$5,621.80 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,575 |
$14,144.80 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,894 |
$10,686.20 |
1.0× |
| Laparoscopic radical prostatectomy (55866) |
$11,562 |
$56,638.10 |
1.0× |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$5,272 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
— |
$14,631.20 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$962 |
$1,595.47 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$962 |
$1,773.66 |
1.0× |
| CT head/brain without contrast (70450) |
$113 |
$2,678 |
1.0× |
| MRI brain without contrast (70551) |
$259 |
$3,922.24 |
1.0× |
| MRI brain with contrast (70552) |
$379 |
$3,289.82 |
1.0× |
| MRI brain without and with contrast (70553) |
$379 |
$5,238.58 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$113 |
$579.43 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$259 |
$5,169.57 |
1.0× |
| CT pelvis with contrast (72193) |
$190 |
$2,675.94 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$259 |
$4,140.81 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$379 |
$3,231.11 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$113 |
$1,689.20 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$113 |
$1,388.44 |
1.0× |
| Ultrasound, transvaginal (76830) |
$113 |
$818.85 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$86 |
$581.95 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$110 |
$533.54 |
1.0× |
| Mammography, screening (bilateral) (77067) |
$91 |
$433.63 |
1.0× |
| Basic metabolic panel (80048) |
$8 |
$211.22 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$293.25 |
0.9× |
| Lipid panel (80061) |
$13 |
$208.64 |
1.0× |
| Renal function panel (80069) |
$8 |
$230 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$221.23 |
1.0× |
| Urinalysis, non-automated, with microscopy (81000) |
$4 |
$20.10 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$37 |
0.9× |
| PSA, total (84153) |
$18 |
$264 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$213 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$127.11 |
0.9× |
| CBC, automated (85027) |
$6 |
$107 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$234.40 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$250 |
1.0× |
| Psychotherapy, 45 minutes (90834) |
$193 |
$759.55 |
1.0× |
| Psychotherapy, 60 minutes (90837) |
$193 |
$759.55 |
1.0× |
| Left heart catheterization (93452) |
$3,526 |
$7,845.51 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$29 |
$136.99 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$362.56 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$489.25 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$616.97 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$340 |
— |