| Breast lesion removal (open) (19120) |
— |
$1,001.65 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$434.15 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$1,526.50 |
— |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
$3,000 |
$1,223.60 |
0.5× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$900 |
$477.90 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$1,750 |
$869.30 |
1.9× |
| Diagnostic colonoscopy (45378) |
$1,250 |
$965.35 |
1.3× |
| Colonoscopy with biopsy (45380) |
$1,950 |
$1,178.30 |
1.6× |
| Colonoscopy with lesion removal (45385) |
— |
$1,364.80 |
— |
| Laparoscopic gallbladder removal (47562) |
$7,500 |
$591.20 |
1.2× |
| Inguinal hernia repair (age 5+) (49505) |
— |
$1,265.90 |
— |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$4,959 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
— |
$5,790 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
— |
$5,239 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$213.20 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$593.80 |
— |
| CT head/brain without contrast (70450) |
$710 |
$2,047.60 |
6.8× |
| MRI brain without contrast (70551) |
$705 |
$2,419.50 |
2.9× |
| MRI brain with contrast (70552) |
$765 |
$2,482.30 |
2.2× |
| MRI brain without and with contrast (70553) |
$730 |
$2,730.50 |
2.1× |
| X-ray lower spine, 4+ views (72110) |
— |
$162.70 |
— |
| MRI lumbar spine without contrast (72148) |
$710 |
$2,482.30 |
3.0× |
| CT pelvis with contrast (72193) |
$642.50 |
$2,285.60 |
3.7× |
| MRI lower-extremity joint without contrast (73721) |
$690 |
$2,540 |
2.9× |
| CT abdomen and pelvis with contrast (74177) |
$602.50 |
$4,724.60 |
1.7× |
| Ultrasound, abdomen complete (76700) |
$245 |
$1,862.20 |
2.3× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$160 |
$721 |
1.5× |
| Ultrasound, transvaginal (76830) |
— |
$621.10 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$157.10 |
— |
| Mammography, both breasts (diagnostic) (77066) |
$150 |
$202.90 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$125 |
$135.45 |
1.4× |
| Basic metabolic panel (80048) |
$15 |
$253.40 |
1.8× |
| Comprehensive metabolic panel (80053) |
$20 |
$385.20 |
1.9× |
| Obstetric panel (80055) |
— |
$570.60 |
— |
| Lipid panel (80061) |
$25 |
$69 |
1.9× |
| Renal function panel (80069) |
$15 |
$494.40 |
1.7× |
| Hepatic function panel (80076) |
$15 |
$167.90 |
1.8× |
| Urinalysis, non-automated, with microscopy (81000) |
$10 |
$14.60 |
2.5× |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$7.20 |
— |
| PSA, total (84153) |
$30 |
$86.55 |
1.6× |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$160.70 |
— |
| CBC with automated differential (85025) |
$15 |
$173 |
1.9× |
| CBC, automated (85027) |
$15 |
$141.15 |
2.3× |
| Prothrombin time (PT) (85610) |
$10 |
$35.60 |
2.3× |
| Partial thromboplastin time (PTT) (85730) |
$10 |
$30 |
1.7× |
| Electrocardiogram (ECG), complete (93000) |
$60 |
$31.40 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$1,500 |
$4,274.50 |
1.7× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$118.50 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$225.10 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$318.05 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$401.90 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$235.35 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$392.65 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$188.20 |
— |