Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$259.20 |
$864 |
0.0× |
| CT head/brain without contrast (70450) |
$449.10 |
$1,497 |
4.9× |
| MRI brain without contrast (70551) |
$708.90 |
$2,363 |
3.4× |
| MRI brain with contrast (70552) |
$724.50 |
$2,415 |
2.4× |
| MRI brain without and with contrast (70553) |
$1,507.20 |
$5,024 |
4.9× |
| X-ray lower spine, 4+ views (72110) |
$240.60 |
$802 |
2.6× |
| MRI lumbar spine without contrast (72148) |
$666.60 |
$2,222 |
3.2× |
| CT pelvis with contrast (72193) |
$733.20 |
$2,444 |
4.8× |
| MRI lower-extremity joint without contrast (73721) |
$885.90 |
$2,953 |
4.2× |
| CT abdomen and pelvis with contrast (74177) |
$1,539 |
$5,130 |
5.0× |
| Ultrasound, abdomen complete (76700) |
$243.90 |
$813 |
2.7× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$234 |
$780 |
2.6× |
| Ultrasound, transvaginal (76830) |
$207 |
$690 |
2.3× |
| Mammography, one breast (diagnostic) (77065) |
$146.70 |
$489 |
1.7× |
| Mammography, both breasts (diagnostic) (77066) |
$151.20 |
$504 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$144.30 |
$481 |
1.6× |
| Basic metabolic panel (80048) |
$13.20 |
$44 |
1.6× |
| Comprehensive metabolic panel (80053) |
$18.30 |
$61 |
1.7× |
| Obstetric panel (80055) |
$748.80 |
$2,496 |
15.7× |
| Lipid panel (80061) |
$18.90 |
$63 |
1.4× |
| Renal function panel (80069) |
$48.60 |
$162 |
5.6× |
| Hepatic function panel (80076) |
$15.60 |
$52 |
1.9× |
| Urinalysis, non-automated, without microscopy (81002) |
$21.60 |
$72 |
6.2× |
| PSA, total (84153) |
$32.10 |
$107 |
1.7× |
| Thyroid stimulating hormone (TSH) (84443) |
$14.10 |
$47 |
0.8× |
| CBC with automated differential (85025) |
$18.30 |
$61 |
2.4× |
| CBC, automated (85027) |
$11.40 |
$38 |
1.8× |
| Prothrombin time (PT) (85610) |
$38.25 |
$127.50 |
8.9× |
| Partial thromboplastin time (PTT) (85730) |
$46.80 |
$156 |
7.8× |
| Electrocardiogram (ECG), complete (93000) |
$12.60 |
$42 |
0.2× |
| Sleep study (attended polysomnography) (95810) |
$1,152 |
$3,840 |
1.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$57.60 |
$192 |
2.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$93.30 |
$311 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$143.40 |
$478 |
1.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$185.85 |
$619.50 |
1.6× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$165.30 |
$551 |
1.4× |