| Shoulder arthroscopy with decompression (29826) |
$329.40 |
$549 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$939.60 |
$1,566 |
0.3× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$498.60 |
$831 |
0.6× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$653.40 |
$1,089 |
0.7× |
| Diagnostic colonoscopy (45378) |
$744.60 |
$1,241 |
0.8× |
| Colonoscopy with biopsy (45380) |
$889.20 |
$1,482 |
0.7× |
| Colonoscopy with lesion removal (45385) |
$1,001.40 |
$1,669 |
0.8× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$1,321.80 |
$2,203 |
0.2× |
| Inguinal hernia repair (age 5+) (49505) |
$1,046.40 |
$1,744 |
0.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$423 |
$705 |
0.5× |
| Cataract removal with lens insertion (66984) |
$1,335.60 |
$2,226 |
0.6× |
| CT head/brain without contrast (70450) |
$1,493.40 |
$2,489 |
14.4× |
| MRI brain without contrast (70551) |
$2,332.20 |
$3,887 |
9.8× |
| MRI brain with contrast (70552) |
$2,544 |
$4,240 |
7.3× |
| MRI brain without and with contrast (70553) |
$3,533.40 |
$5,889 |
10.2× |
| X-ray lower spine, 4+ views (72110) |
$430.20 |
$717 |
4.1× |
| MRI lumbar spine without contrast (72148) |
$2,166.60 |
$3,611 |
9.1× |
| CT pelvis with contrast (72193) |
$1,762.20 |
$2,937 |
10.1× |
| MRI lower-extremity joint without contrast (73721) |
$2,230.80 |
$3,718 |
9.4× |
| CT abdomen and pelvis with contrast (74177) |
$4,371.60 |
$7,286 |
12.6× |
| Ultrasound, abdomen complete (76700) |
$738.60 |
$1,231 |
7.1× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$433.20 |
$722 |
4.2× |
| Ultrasound, transvaginal (76830) |
$262.80 |
$438 |
2.5× |
| Mammography, one breast (diagnostic) (77065) |
$256.20 |
$427 |
3.0× |
| Mammography, both breasts (diagnostic) (77066) |
$406.80 |
$678 |
3.7× |
| Mammography, screening (bilateral) (77067) |
$273 |
$455 |
3.0× |
| Basic metabolic panel (80048) |
$220.20 |
$367 |
26.0× |
| Comprehensive metabolic panel (80053) |
$293.40 |
$489 |
27.8× |
| Lipid panel (80061) |
$103.80 |
$173 |
7.8× |
| Renal function panel (80069) |
$235.20 |
$392 |
27.1× |
| Hepatic function panel (80076) |
$192.60 |
$321 |
23.6× |
| Urinalysis, non-automated, without microscopy (81002) |
$31.20 |
$52 |
9.0× |
| PSA, total (84153) |
$132.90 |
$221.50 |
7.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$94.80 |
$158 |
5.6× |
| CBC with automated differential (85025) |
$105 |
$175 |
13.5× |
| CBC, automated (85027) |
$75 |
$125 |
11.6× |
| Prothrombin time (PT) (85610) |
$17.40 |
$29 |
4.1× |
| Partial thromboplastin time (PTT) (85730) |
$66.90 |
$111.50 |
11.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$79.20 |
$132 |
2.7× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$161.40 |
$269 |
1.2× |
| Office consultation (low complexity, ~30 min) (99243) |
$221.40 |
$369 |
1.7× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$332.40 |
$554 |
2.5× |