| Shoulder arthroscopy with decompression (29826) |
— |
$2,853.85 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$3,261 |
$4,657.31 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$903 |
$5,943.40 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$903 |
$5,285.29 |
1.0× |
| Diagnostic colonoscopy (45378) |
$926 |
$5,388.22 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,192 |
$5,292.48 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,192 |
$6,841.20 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,025 |
$18,389.30 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,568 |
$14,856.85 |
1.0× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$881 |
$1,718.75 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$881 |
$4,593.44 |
1.0× |
| CT head/brain without contrast (70450) |
$104 |
$4,170.67 |
1.0× |
| MRI brain without contrast (70551) |
$237 |
$5,453.42 |
1.0× |
| MRI brain with contrast (70552) |
$347 |
$5,090.86 |
1.0× |
| MRI brain without and with contrast (70553) |
$347 |
$7,780.27 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$104 |
$1,238.01 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$237 |
$5,430.47 |
1.0× |
| CT pelvis with contrast (72193) |
$174 |
$4,527.50 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$237 |
$7,327.06 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$347 |
$8,068.26 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$104 |
$1,873.64 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$104 |
$1,688.92 |
1.0× |
| Ultrasound, transvaginal (76830) |
$104 |
$1,232.27 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$80 |
$647.12 |
0.9× |
| Mammography, both breasts (diagnostic) (77066) |
$103 |
$684.98 |
0.9× |
| Mammography, screening (bilateral) (77067) |
$85 |
$608.11 |
0.9× |
| Basic metabolic panel (80048) |
$8 |
$399.28 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$563.36 |
0.9× |
| Lipid panel (80061) |
$13 |
$400.42 |
1.0× |
| Renal function panel (80069) |
$8 |
$401.59 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$396.99 |
1.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$3 |
$17.92 |
0.9× |
| PSA, total (84153) |
$18 |
$306.34 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$322.41 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$359.13 |
0.9× |
| CBC, automated (85027) |
$6 |
$359.13 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$359.13 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$448.63 |
1.0× |
| Electrocardiogram (ECG), complete (93000) |
— |
$349.05 |
— |
| Left heart catheterization (93452) |
$3,231 |
$16,180.70 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$855 |
$9,049.25 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$28 |
$359.13 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$964.93 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$1,002.80 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$1,122.12 |
— |