| Breast lesion removal (open) (19120) |
$898.50 |
$1,797 |
0.2× |
| Shoulder arthroscopy with decompression (29826) |
$188.50 |
$377 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,653 |
$3,306 |
0.5× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$307.50 |
$615 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$172 |
$344 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$259 |
$518 |
0.3× |
| Diagnostic colonoscopy (45378) |
$647.50 |
$1,295 |
0.7× |
| Colonoscopy with biopsy (45380) |
$769.50 |
$1,539 |
0.6× |
| Colonoscopy with lesion removal (45385) |
$867 |
$1,734 |
0.7× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$878.50 |
$1,757 |
0.1× |
| Inguinal hernia repair (age 5+) (49505) |
$636 |
$1,272 |
0.2× |
| Obstetric care, vaginal delivery (global) (59400) |
$2,266 |
$4,532 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$2,515 |
$5,030 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$1,979 |
$3,958 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$292 |
$584 |
0.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$180 |
$360 |
0.2× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$818.75 |
$1,637.50 |
1.5× |
| CT head/brain without contrast (70450) |
$620.25 |
$1,240.50 |
5.9× |
| MRI brain without contrast (70551) |
$793.75 |
$1,587.50 |
3.3× |
| MRI brain with contrast (70552) |
$902.25 |
$1,804.50 |
2.6× |
| MRI brain without and with contrast (70553) |
$1,134.75 |
$2,269.50 |
3.2× |
| X-ray lower spine, 4+ views (72110) |
$171.25 |
$342.50 |
1.6× |
| MRI lumbar spine without contrast (72148) |
$868.50 |
$1,737 |
3.6× |
| CT pelvis with contrast (72193) |
$722 |
$1,444 |
4.1× |
| MRI lower-extremity joint without contrast (73721) |
$1,708.50 |
$3,417 |
7.1× |
| CT abdomen and pelvis with contrast (74177) |
$1,371.88 |
$2,743.75 |
3.9× |
| Ultrasound, abdomen complete (76700) |
$270.25 |
$540.50 |
2.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$407.50 |
$815 |
3.9× |
| Ultrasound, transvaginal (76830) |
$305 |
$610 |
2.9× |
| Mammography, one breast (diagnostic) (77065) |
$350.75 |
$701.50 |
4.1× |
| Mammography, both breasts (diagnostic) (77066) |
$340 |
$680 |
3.1× |
| Mammography, screening (bilateral) (77067) |
$354.62 |
$709.25 |
3.9× |
| Basic metabolic panel (80048) |
$87.75 |
$175.50 |
10.4× |
| Comprehensive metabolic panel (80053) |
$54.12 |
$108.25 |
5.1× |
| Obstetric panel (80055) |
$295.25 |
$590.50 |
6.2× |
| Lipid panel (80061) |
$23 |
$46 |
1.7× |
| Renal function panel (80069) |
$110.50 |
$221 |
12.7× |
| Hepatic function panel (80076) |
$63.50 |
$127 |
7.8× |
| Urinalysis, non-automated, with microscopy (81000) |
$12 |
$24 |
3.0× |
| Urinalysis, non-automated, without microscopy (81002) |
$16.75 |
$33.50 |
4.8× |
| PSA, total (84153) |
$94.25 |
$188.50 |
5.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$27 |
$54 |
1.6× |
| CBC with automated differential (85025) |
$16.50 |
$33 |
2.1× |
| CBC, automated (85027) |
$54 |
$108 |
8.3× |
| Prothrombin time (PT) (85610) |
$37 |
$74 |
8.6× |
| Partial thromboplastin time (PTT) (85730) |
$55.50 |
$111 |
9.2× |
| Psychotherapy, 30 minutes (90832) |
$67.50 |
$135 |
0.4× |
| Psychotherapy, 45 minutes (90834) |
$89 |
$178 |
0.5× |
| Psychotherapy, 60 minutes (90837) |
$107.50 |
$215 |
0.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$66 |
$132 |
0.4× |
| Family psychotherapy, with patient (50 min) (90847) |
$82.50 |
$165 |
0.5× |
| Group psychotherapy (90853) |
$103 |
$206 |
1.0× |
| Electrocardiogram (ECG), complete (93000) |
$27.62 |
$55.25 |
0.5× |
| Sleep study (attended polysomnography) (95810) |
$1,251.38 |
$2,502.75 |
1.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$128.12 |
$256.25 |
4.4× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$170.88 |
$341.75 |
1.3× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$241.50 |
$483 |
1.8× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$305.88 |
$611.75 |
2.3× |
| Office consultation (low complexity, ~30 min) (99243) |
$147.50 |
$295 |
1.1× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$227.62 |
$455.25 |
1.7× |
| Preventive visit, new patient (age 18–39) (99385) |
$151.50 |
$303 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$165 |
$330 |
— |