| Breast lesion removal (open) (19120) |
$4,412.27 |
— |
1.2× |
| Knee arthroscopy with meniscectomy (29881) |
$3,746.79 |
— |
1.2× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$6,778.80 |
— |
1.2× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,049.30 |
— |
1.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,049.30 |
— |
1.2× |
| Diagnostic colonoscopy (45378) |
$1,057.95 |
— |
1.2× |
| Colonoscopy with biopsy (45380) |
$1,365.99 |
— |
1.2× |
| Colonoscopy with lesion removal (45385) |
$1,365.99 |
— |
1.2× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,365.99 |
— |
1.2× |
| Laparoscopic gallbladder removal (47562) |
$6,679.03 |
— |
1.1× |
| Inguinal hernia repair (age 5+) (49505) |
$4,004.73 |
— |
1.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,055.08 |
— |
1.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,055.08 |
— |
1.2× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$672.85 |
— |
1.3× |
| Cataract removal with lens insertion (66984) |
$2,697.51 |
— |
1.2× |
| CT head/brain without contrast (70450) |
$127.26 |
— |
1.3× |
| MRI brain without contrast (70551) |
$283.64 |
— |
1.2× |
| MRI brain with contrast (70552) |
$445.16 |
— |
1.3× |
| MRI brain without and with contrast (70553) |
$445.16 |
— |
1.3× |
| X-ray lower spine, 4+ views (72110) |
$127.26 |
— |
1.3× |
| MRI lumbar spine without contrast (72148) |
$283.64 |
— |
1.2× |
| CT pelvis with contrast (72193) |
$212.68 |
— |
1.3× |
| MRI lower-extremity joint without contrast (73721) |
$283.64 |
— |
1.2× |
| CT abdomen and pelvis with contrast (74177) |
$445.16 |
— |
1.3× |
| Ultrasound, abdomen complete (76700) |
$127.26 |
— |
1.3× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$127.26 |
— |
1.3× |
| Ultrasound, transvaginal (76830) |
$127.26 |
— |
1.3× |
| Basic metabolic panel (80048) |
$11 |
— |
1.3× |
| Comprehensive metabolic panel (80053) |
$13.73 |
— |
1.3× |
| Obstetric panel (80055) |
$62.15 |
— |
1.3× |
| Lipid panel (80061) |
$17.41 |
— |
1.3× |
| Renal function panel (80069) |
$11.28 |
— |
1.3× |
| Hepatic function panel (80076) |
$10.62 |
— |
1.3× |
| Urinalysis, non-automated, with microscopy (81000) |
$5.23 |
— |
1.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$4.52 |
— |
1.3× |
| PSA, total (84153) |
$23.91 |
— |
1.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$21.84 |
— |
1.3× |
| CBC with automated differential (85025) |
$10.10 |
— |
1.3× |
| CBC, automated (85027) |
$8.41 |
— |
1.3× |
| Prothrombin time (PT) (85610) |
$5.58 |
— |
1.3× |
| Partial thromboplastin time (PTT) (85730) |
$7.81 |
— |
1.3× |
| Sleep study (attended polysomnography) (95810) |
$1,210.26 |
— |
1.5× |