| Shoulder arthroscopy with decompression (29826) |
$1,842 |
— |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,748 |
— |
0.4× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$328.56 |
$551 |
0.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$535.33 |
$897.75 |
0.5× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$619.70 |
$1,039.25 |
0.5× |
| Diagnostic colonoscopy (45378) |
$721.52 |
$1,210 |
0.6× |
| Colonoscopy with biopsy (45380) |
$794.27 |
$1,332 |
0.5× |
| Colonoscopy with lesion removal (45385) |
$1,022.65 |
$1,715 |
0.7× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$2,080.64 |
$3,489.25 |
0.3× |
| Inguinal hernia repair (age 5+) (49505) |
$1,047 |
— |
0.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$477.04 |
$800 |
0.4× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$250.74 |
$420.50 |
0.2× |
| CT head/brain without contrast (70450) |
$202 |
— |
1.5× |
| MRI brain without contrast (70551) |
$460 |
— |
1.5× |
| MRI brain with contrast (70552) |
$679 |
— |
1.6× |
| MRI brain without and with contrast (70553) |
$679 |
— |
1.6× |
| X-ray lower spine, 4+ views (72110) |
$202 |
— |
1.5× |
| MRI lumbar spine without contrast (72148) |
$460 |
— |
1.5× |
| CT pelvis with contrast (72193) |
$338 |
— |
1.5× |
| MRI lower-extremity joint without contrast (73721) |
$460 |
— |
1.5× |
| CT abdomen and pelvis with contrast (74177) |
$679 |
— |
1.6× |
| Ultrasound, abdomen complete (76700) |
$202 |
— |
1.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$202 |
— |
1.5× |
Ultrasound, transvaginal (76830)
range across 2 matching MRF lines |
$28–$202 |
— |
varies |
| Mammography, one breast (diagnostic) (77065) |
$157 |
— |
1.8× |
| Mammography, both breasts (diagnostic) (77066) |
$157 |
— |
1.4× |
| Mammography, screening (bilateral) (77067) |
$152 |
— |
1.7× |
| Basic metabolic panel (80048) |
$48 |
— |
5.7× |
| Comprehensive metabolic panel (80053) |
$78 |
— |
7.4× |
| Lipid panel (80061) |
$59 |
— |
4.4× |
| Renal function panel (80069) |
$60 |
— |
6.9× |
| Hepatic function panel (80076) |
$51 |
— |
6.2× |
| Urinalysis, non-automated, with microscopy (81000) |
$30 |
— |
7.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$16 |
— |
4.6× |
| PSA, total (84153) |
$132 |
— |
7.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$92 |
— |
5.5× |
| CBC with automated differential (85025) |
$38 |
— |
4.9× |
| CBC, automated (85027) |
$34 |
— |
5.3× |
Prothrombin time (PT) (85610)
range across 2 matching MRF lines |
$27–$28 |
— |
varies |
Partial thromboplastin time (PTT) (85730)
range across 2 matching MRF lines |
$42–$46 |
— |
varies |
| Electrocardiogram (ECG), complete (93000) |
$80.95 |
$135.75 |
1.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$73 |
— |
2.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$130.44 |
$218.75 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$189.77 |
$318.25 |
1.1× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$240.16 |
$402.75 |
1.4× |