| Breast lesion removal (open) (19120) |
$4,804.80 |
$7,300 |
1.1× |
| Knee arthroscopy with meniscectomy (29881) |
$4,015.22 |
— |
1.2× |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$7,264.49 |
$7,500 |
1.1× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$1,113 |
$3,390 |
1.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,113 |
$2,270 |
1.1× |
| Diagnostic colonoscopy (45378) |
$1,141.19 |
$3,010 |
1.1× |
| Colonoscopy with biopsy (45380) |
$1,468.45 |
$3,520 |
1.1× |
| Colonoscopy with lesion removal (45385) |
$1,468.45 |
$3,520 |
1.1× |
| Colonoscopy with endoscopic ultrasound (45391) |
$1,468.45 |
$3,340 |
1.1× |
| Laparoscopic gallbladder removal (47562) |
$7,418.74 |
— |
1.1× |
| Inguinal hernia repair (age 5+) (49505) |
$4,393.67 |
— |
1.2× |
| Laparoscopic radical prostatectomy (55866) |
$13,044.35 |
— |
1.2× |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,085.38 |
$1,600 |
1.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,085.38 |
$2,060 |
1.1× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$674.93 |
$1,830 |
1.2× |
| Cataract removal with lens insertion (66984) |
$2,832.03 |
$4,500 |
1.1× |
| CT head/brain without contrast (70450) |
$128.29 |
$4,000 |
1.1× |
| MRI brain without contrast (70551) |
$292.80 |
$3,000 |
1.1× |
| MRI brain with contrast (70552) |
$428.12 |
$3,300 |
1.1× |
| MRI brain without and with contrast (70553) |
$428.12 |
$5,500 |
1.1× |
| X-ray lower spine, 4+ views (72110) |
$128.29 |
$1,000 |
1.1× |
| MRI lumbar spine without contrast (72148) |
$292.80 |
$3,200 |
1.1× |
| CT pelvis with contrast (72193) |
$215.24 |
$4,200 |
1.1× |
| MRI lower-extremity joint without contrast (73721) |
$292.80 |
$2,800 |
1.1× |
| CT abdomen and pelvis with contrast (74177) |
$428.12 |
$7,500 |
1.1× |
| Ultrasound, abdomen complete (76700) |
$128.29 |
$1,100 |
1.1× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$128.29 |
$880 |
1.1× |
| Ultrasound, transvaginal (76830) |
$128.29 |
$1,650 |
1.1× |
| Mammography, one breast (diagnostic) (77065) |
$193.33 |
$450 |
2.2× |
| Mammography, both breasts (diagnostic) (77066) |
$245.04 |
$680 |
2.2× |
| Mammography, screening (bilateral) (77067) |
$198.19 |
$580 |
2.2× |
| Basic metabolic panel (80048) |
$9.73 |
$350 |
1.2× |
| Comprehensive metabolic panel (80053) |
$12.14 |
$380 |
1.1× |
| Obstetric panel (80055) |
$54.98 |
— |
1.1× |
| Lipid panel (80061) |
$15.40 |
$220 |
1.2× |
| Renal function panel (80069) |
$9.98 |
$160 |
1.1× |
| Hepatic function panel (80076) |
$9.40 |
$250 |
1.2× |
| Urinalysis, non-automated, with microscopy (81000) |
$4.62 |
$31 |
1.1× |
| Urinalysis, non-automated, without microscopy (81002) |
$4 |
$51 |
1.1× |
| PSA, total (84153) |
$21.15 |
$160 |
1.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$19.32 |
$170 |
1.2× |
| CBC with automated differential (85025) |
$8.94 |
$140 |
1.2× |
| CBC, automated (85027) |
$7.44 |
$110 |
1.1× |
| Prothrombin time (PT) (85610) |
$4.93 |
$80 |
1.1× |
| Partial thromboplastin time (PTT) (85730) |
$6.91 |
$120 |
1.1× |
| Psychotherapy, 30 minutes (90832) |
$217.81 |
$370 |
1.2× |
| Psychotherapy, 45 minutes (90834) |
$217.81 |
$410 |
1.2× |
| Psychotherapy, 60 minutes (90837) |
$217.81 |
$500 |
1.2× |
| Family psychotherapy, without patient (50 min) (90846) |
$217.81 |
$280 |
1.2× |
| Family psychotherapy, with patient (50 min) (90847) |
$217.81 |
$410 |
1.2× |
| Group psychotherapy (90853) |
$124.67 |
$200 |
1.2× |
| Electrocardiogram (ECG), complete (93000) |
— |
$47 |
— |
| Left heart catheterization (93452) |
$3,978.32 |
$7,600 |
1.1× |
| Sleep study (attended polysomnography) (95810) |
$1,053.80 |
— |
1.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$42.91 |
$359.50 |
1.5× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$140 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$200 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$250 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$800 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$1,200 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$190 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$460 |
— |