| Breast lesion removal (open) (19120) |
$757.60 |
$947 |
0.2× |
| Shoulder arthroscopy with decompression (29826) |
$309.60 |
$387 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$1,248.80 |
$1,561 |
0.4× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$224.80 |
$281 |
0.3× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$253.60 |
$317 |
0.3× |
| Diagnostic colonoscopy (45378) |
$336.80 |
$421 |
0.4× |
| Colonoscopy with biopsy (45380) |
$366.40 |
$458 |
0.3× |
| Colonoscopy with lesion removal (45385) |
$464 |
$580 |
0.4× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,189.60 |
$1,487 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$945.60 |
$1,182 |
0.3× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$472 |
$590 |
0.5× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,064 |
$1,330 |
1.2× |
| CT head/brain without contrast (70450) |
$1,089.60 |
$1,362 |
10.5× |
| MRI brain without contrast (70551) |
$1,858.40 |
$2,323 |
7.9× |
| MRI brain with contrast (70552) |
$2,289.60 |
$2,862 |
6.6× |
| MRI brain without and with contrast (70553) |
$2,459.20 |
$3,074 |
7.1× |
| X-ray lower spine, 4+ views (72110) |
$421.60 |
$527 |
4.1× |
| MRI lumbar spine without contrast (72148) |
$1,446.40 |
$1,808 |
6.1× |
| CT pelvis with contrast (72193) |
$1,494.40 |
$1,868 |
8.6× |
| MRI lower-extremity joint without contrast (73721) |
$1,199.20 |
$1,499 |
5.1× |
| CT abdomen and pelvis with contrast (74177) |
$2,300 |
$2,875 |
6.7× |
| Ultrasound, abdomen complete (76700) |
$636 |
$795 |
6.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$356.80 |
$446 |
3.5× |
| Ultrasound, transvaginal (76830) |
$155.20 |
$194 |
1.5× |
| Mammography, one breast (diagnostic) (77065) |
$271.20 |
$339 |
3.1× |
| Mammography, both breasts (diagnostic) (77066) |
$352.80 |
$441 |
3.2× |
| Mammography, screening (bilateral) (77067) |
$304 |
$380 |
3.3× |
| Basic metabolic panel (80048) |
$83.20 |
$104 |
9.8× |
| Comprehensive metabolic panel (80053) |
$103.20 |
$129 |
9.8× |
| Obstetric panel (80055) |
$196 |
$245 |
4.1× |
| Lipid panel (80061) |
$81.20 |
$101.50 |
6.1× |
| Renal function panel (80069) |
$77.60 |
$97 |
8.9× |
| Hepatic function panel (80076) |
$72.80 |
$91 |
8.9× |
| Urinalysis, non-automated, with microscopy (81000) |
$36.80 |
$46 |
9.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$26.40 |
$33 |
7.6× |
| PSA, total (84153) |
$190 |
$237.50 |
10.3× |
| Thyroid stimulating hormone (TSH) (84443) |
$88 |
$110 |
5.2× |
| CBC with automated differential (85025) |
$66.40 |
$83 |
8.5× |
| CBC, automated (85027) |
$59.20 |
$74 |
9.1× |
| Prothrombin time (PT) (85610) |
$37.20 |
$46.50 |
8.7× |
| Partial thromboplastin time (PTT) (85730) |
$67.20 |
$84 |
11.2× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$62.40 |
$78 |
2.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$101.60 |
$127 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$160.80 |
$201 |
1.2× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$218.40 |
$273 |
1.7× |
| Office consultation (low complexity, ~30 min) (99243) |
$205.60 |
$257 |
1.6× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$300 |
$375 |
2.3× |