| Breast lesion removal (open) (19120) |
$54.17 |
— |
0.0× |
| Shoulder arthroscopy with decompression (29826) |
$54.17 |
— |
— |
| Knee arthroscopy with meniscectomy (29881) |
$54.17 |
— |
0.0× |
Tonsillectomy and adenoidectomy (under age 12) (42820)
likely a partial charge, not the full procedure |
$54.17 |
— |
0.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$54.17 |
— |
0.1× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$54.17 |
— |
0.1× |
| Diagnostic colonoscopy (45378) |
$54.17 |
— |
0.1× |
| Colonoscopy with biopsy (45380) |
$54.17 |
— |
0.1× |
| Colonoscopy with lesion removal (45385) |
$54.17 |
— |
0.1× |
| Colonoscopy with endoscopic ultrasound (45391) |
$54.17 |
— |
0.1× |
Laparoscopic gallbladder removal (47562)
likely a partial charge, not the full procedure |
$54.17 |
— |
0.0× |
| Inguinal hernia repair (age 5+) (49505) |
$54.17 |
— |
0.0× |
Laparoscopic radical prostatectomy (55866)
likely a partial charge, not the full procedure |
$54.17 |
— |
0.0× |
| Obstetric care, vaginal delivery (global) (59400) |
$54.17 |
— |
— |
| Obstetric care, cesarean delivery (global) (59510) |
$54.17 |
— |
— |
| Obstetric care, VBAC delivery (global) (59610) |
$54.17 |
— |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
$54.17 |
— |
0.1× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$54.17 |
— |
0.1× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$54.17 |
— |
0.1× |
| Cataract removal with lens insertion (66984) |
$54.17 |
— |
0.0× |
| CT head/brain without contrast (70450) |
$54.17 |
$520.74 |
0.6× |
| MRI brain without contrast (70551) |
$54.17 |
— |
0.3× |
| MRI brain with contrast (70552) |
$54.17 |
— |
0.2× |
| MRI brain without and with contrast (70553) |
$54.17 |
— |
0.2× |
| X-ray lower spine, 4+ views (72110) |
$54.17 |
$343.38 |
0.6× |
| MRI lumbar spine without contrast (72148) |
$54.17 |
— |
0.3× |
| CT pelvis with contrast (72193) |
$54.17 |
$891.45 |
0.4× |
| MRI lower-extremity joint without contrast (73721) |
$54.17 |
— |
0.3× |
| CT abdomen and pelvis with contrast (74177) |
$54.17 |
$1,447.74 |
0.2× |
| Ultrasound, abdomen complete (76700) |
$54.17 |
$555.63 |
0.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$54.17 |
$404 |
0.6× |
| Ultrasound, transvaginal (76830) |
$54.17 |
$343.08 |
0.6× |
| Mammography, one breast (diagnostic) (77065) |
$54.17 |
$404.91 |
0.6× |
| Mammography, both breasts (diagnostic) (77066) |
$54.17 |
$462.72 |
0.5× |
| Mammography, screening (bilateral) (77067) |
$54.17 |
$400.92 |
0.6× |
| Basic metabolic panel (80048) |
$54.17 |
$65.05 |
6.4× |
| Comprehensive metabolic panel (80053) |
$54.17 |
$62.58 |
5.1× |
| Obstetric panel (80055) |
$54.17 |
— |
1.1× |
| Lipid panel (80061) |
$54.17 |
$49.80 |
4.0× |
| Renal function panel (80069) |
$54.17 |
$51.39 |
6.2× |
| Hepatic function panel (80076) |
$54.17 |
$48.36 |
6.6× |
| Urinalysis, non-automated, with microscopy (81000) |
$54.17 |
$22.88 |
13.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$54.17 |
— |
15.6× |
| PSA, total (84153) |
$54.17 |
$108.87 |
2.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$54.17 |
$99.45 |
3.2× |
| CBC with automated differential (85025) |
$54.17 |
$45 |
7.0× |
| CBC, automated (85027) |
$54.17 |
$36 |
8.4× |
| Prothrombin time (PT) (85610) |
$54.17 |
$23.25 |
12.6× |
| Partial thromboplastin time (PTT) (85730) |
$54.17 |
$35.52 |
9.0× |
| Psychotherapy, 30 minutes (90832) |
$54.17 |
— |
0.4× |
| Psychotherapy, 45 minutes (90834) |
$54.17 |
— |
0.4× |
| Psychotherapy, 60 minutes (90837) |
$54.17 |
— |
0.4× |
| Family psychotherapy, without patient (50 min) (90846) |
$54.17 |
— |
0.4× |
| Family psychotherapy, with patient (50 min) (90847) |
$54.17 |
— |
0.4× |
| Group psychotherapy (90853) |
$54.17 |
— |
0.6× |
| Electrocardiogram (ECG), complete (93000) |
$54.17 |
— |
1.1× |
| Left heart catheterization (93452) |
$54.17 |
— |
0.0× |
| Sleep study (attended polysomnography) (95810) |
$54.17 |
— |
0.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$54.17 |
— |
1.9× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$54.17 |
$290.88 |
0.5× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$54.17 |
— |
0.5× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$54.17 |
— |
0.5× |
| Office consultation (low complexity, ~30 min) (99243) |
$54.17 |
— |
0.5× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$54.17 |
— |
0.5× |
| Preventive visit, new patient (age 18–39) (99385) |
$54.17 |
— |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$54.17 |
— |
— |