| Breast lesion removal (open) (19120) |
$4,895.48 |
— |
1.3× |
| Knee arthroscopy with meniscectomy (29881) |
$4,090.98 |
— |
1.3× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$7,401.56 |
— |
1.3× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,134 |
— |
1.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,134 |
— |
1.3× |
| Diagnostic colonoscopy (45378) |
$1,162.73 |
— |
1.3× |
| Colonoscopy with biopsy (45380) |
$1,496.16 |
— |
1.3× |
| Colonoscopy with lesion removal (45385) |
$1,496.16 |
— |
1.3× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,496.16 |
— |
1.3× |
| Laparoscopic gallbladder removal (47562) |
$7,558.73 |
— |
1.3× |
| Inguinal hernia repair (age 5+) (49505) |
$4,476.58 |
— |
1.3× |
| Laparoscopic radical prostatectomy (55866) |
$13,290.49 |
— |
1.3× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,105.86 |
$675 |
1.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,105.86 |
$3,545 |
1.3× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$687.66 |
— |
1.3× |
| Cataract removal with lens insertion (66984) |
$2,885.48 |
— |
1.3× |
| CT head/brain without contrast (70450) |
$130.72 |
$906 |
1.3× |
| MRI brain without contrast (70551) |
$298.32 |
— |
1.3× |
| MRI brain with contrast (70552) |
$436.20 |
— |
1.3× |
| MRI brain without and with contrast (70553) |
$436.20 |
— |
1.3× |
| X-ray lower spine, 4+ views (72110) |
$130.72 |
$331 |
1.3× |
| MRI lumbar spine without contrast (72148) |
$298.32 |
$1,690 |
1.3× |
| CT pelvis with contrast (72193) |
$219.31 |
— |
1.3× |
| MRI lower-extremity joint without contrast (73721) |
$298.32 |
— |
1.3× |
| CT abdomen and pelvis with contrast (74177) |
$436.20 |
$1,690 |
1.3× |
| Ultrasound, abdomen complete (76700) |
$130.72 |
— |
1.3× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$130.72 |
— |
1.3× |
| Ultrasound, transvaginal (76830) |
$130.72 |
— |
1.3× |
| Basic metabolic panel (80048) |
$11 |
$26 |
1.3× |
| Comprehensive metabolic panel (80053) |
$13.73 |
$26 |
1.3× |
| Obstetric panel (80055) |
$62.15 |
— |
1.3× |
| Lipid panel (80061) |
$17.41 |
$20 |
1.3× |
| Renal function panel (80069) |
$11.28 |
$5.20 |
1.3× |
| Hepatic function panel (80076) |
$10.62 |
$107 |
1.3× |
| Urinalysis, non-automated, with microscopy (81000) |
$5.23 |
— |
1.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.52 |
$11 |
1.3× |
| PSA, total (84153) |
$23.91 |
$20 |
1.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$21.84 |
$50.50 |
1.3× |
| CBC with automated differential (85025) |
$10.10 |
$11 |
1.3× |
| CBC, automated (85027) |
$8.41 |
$11 |
1.3× |
| Prothrombin time (PT) (85610) |
$5.58 |
$20 |
1.3× |
| Partial thromboplastin time (PTT) (85730) |
$7.81 |
$5 |
1.3× |
| Psychotherapy, 30 minutes (90832) |
$221.92 |
— |
1.3× |
| Psychotherapy, 45 minutes (90834) |
$221.92 |
— |
1.3× |
| Psychotherapy, 60 minutes (90837) |
$221.92 |
— |
1.3× |
| Family psychotherapy, without patient (50 min) (90846) |
$221.92 |
— |
1.3× |
| Family psychotherapy, with patient (50 min) (90847) |
$221.92 |
— |
1.3× |
| Group psychotherapy (90853) |
$127.02 |
— |
1.3× |
| Left heart catheterization (93452) |
$4,053.39 |
— |
1.3× |
| Sleep study (attended polysomnography) (95810) |
$1,073.68 |
— |
1.3× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$62 |
— |