| Breast lesion removal (open) (19120) |
$1,310.40 |
$2,016 |
0.4× |
| Shoulder arthroscopy with decompression (29826) |
$258.70 |
$398 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$836.55 |
$1,287 |
0.3× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$449.15 |
$691 |
0.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$208.65 |
$321 |
0.2× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$234.65 |
$361 |
0.3× |
| Diagnostic colonoscopy (45378) |
$338.65 |
$521 |
0.4× |
| Colonoscopy with biopsy (45380) |
$404.95 |
$623 |
0.4× |
| Colonoscopy with lesion removal (45385) |
$481 |
$740 |
0.4× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,053.65 |
$1,621 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$1,248 |
$1,920 |
0.4× |
Laparoscopic radical prostatectomy (55866)
likely a partial charge, not the full procedure |
$2,333.50 |
$3,590 |
0.2× |
| Obstetric care, vaginal delivery (global) (59400) |
$3,714.75 |
$5,715 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$4,098.25 |
$6,305 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$3,880.50 |
$5,970 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$939.90 |
$1,446 |
1.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$648.70 |
$998 |
0.8× |
| CT head/brain without contrast (70450) |
$542.75 |
$835 |
5.5× |
| MRI brain without contrast (70551) |
$775.12 |
$1,192.50 |
3.4× |
| MRI brain with contrast (70552) |
$839.80 |
$1,292 |
2.5× |
| MRI brain without and with contrast (70553) |
$1,555.12 |
$2,392.50 |
4.7× |
| X-ray lower spine, 4+ views (72110) |
$171.60 |
$264 |
1.7× |
| MRI lumbar spine without contrast (72148) |
$937.95 |
$1,443 |
4.1× |
| CT pelvis with contrast (72193) |
$684.45 |
$1,053 |
4.1× |
| MRI lower-extremity joint without contrast (73721) |
$812.50 |
$1,250 |
3.6× |
| CT abdomen and pelvis with contrast (74177) |
$1,349.72 |
$2,076.50 |
4.1× |
| Ultrasound, abdomen complete (76700) |
$346.45 |
$533 |
3.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$156.32 |
$240.50 |
1.6× |
| Ultrasound, transvaginal (76830) |
$384.15 |
$591 |
3.9× |
| Mammography, one breast (diagnostic) (77065) |
$199.55 |
$307 |
2.3× |
| Mammography, both breasts (diagnostic) (77066) |
$158.92 |
$244.50 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$140.40 |
$216 |
1.5× |
| Basic metabolic panel (80048) |
$68.90 |
$106 |
8.1× |
| Comprehensive metabolic panel (80053) |
$120.25 |
$185 |
11.4× |
| Lipid panel (80061) |
$54.28 |
$83.50 |
4.1× |
| Renal function panel (80069) |
$85.80 |
$132 |
9.9× |
| Hepatic function panel (80076) |
$59.80 |
$92 |
7.3× |
| Urinalysis, non-automated, without microscopy (81002) |
$13 |
$20 |
3.7× |
| PSA, total (84153) |
$39 |
$60 |
2.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$45.50 |
$70 |
2.7× |
| CBC with automated differential (85025) |
$32.18 |
$49.50 |
4.1× |
| CBC, automated (85027) |
$67.60 |
$104 |
10.4× |
| Prothrombin time (PT) (85610) |
$39.98 |
$61.50 |
9.3× |
| Partial thromboplastin time (PTT) (85730) |
$56.55 |
$87 |
9.4× |
| Psychotherapy, 30 minutes (90832) |
$135.85 |
$209 |
0.8× |
| Psychotherapy, 45 minutes (90834) |
$180.05 |
$277 |
1.1× |
| Psychotherapy, 60 minutes (90837) |
$208 |
$320 |
1.2× |
| Sleep study (attended polysomnography) (95810) |
$807.95 |
$1,243 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$60.45 |
$93 |
2.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$156.98 |
$241.50 |
1.2× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$213.20 |
$328 |
1.7× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$289.25 |
$445 |
2.3× |
| Preventive visit, new patient (age 18–39) (99385) |
$116.35 |
$179 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$116.35 |
$179 |
— |