| Breast lesion removal (open) (19120) |
— |
$1,288 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$58 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$58 |
— |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
— |
$1,772 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$343.39 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$393.50 |
— |
| Diagnostic colonoscopy (45378) |
— |
$419 |
— |
| Colonoscopy with biopsy (45380) |
— |
$594 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$582 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$58 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$1,265 |
— |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$58 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
— |
$58 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
— |
$1,431 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$698 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$2,032 |
— |
| Cataract removal with lens insertion (66984) |
— |
$1,734.75 |
— |
| CT head/brain without contrast (70450) |
— |
$2,500 |
— |
| MRI brain without contrast (70551) |
— |
$2,500 |
— |
| MRI brain with contrast (70552) |
— |
$2,785 |
— |
| MRI brain without and with contrast (70553) |
— |
$6,347 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$628 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$5,025 |
— |
| CT pelvis with contrast (72193) |
— |
$2,500 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$4,650 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$8,112 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$2,650 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$867 |
— |
| Ultrasound, transvaginal (76830) |
— |
$795 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$283 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$318 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$318 |
— |
| Basic metabolic panel (80048) |
— |
$219 |
— |
| Comprehensive metabolic panel (80053) |
— |
$351 |
— |
| Lipid panel (80061) |
— |
$170.50 |
— |
| Hepatic function panel (80076) |
— |
$250 |
— |
| Urinalysis, non-automated, with microscopy (81000) |
— |
$10.50 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$13 |
— |
| PSA, total (84153) |
— |
$88 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$188 |
— |
| CBC with automated differential (85025) |
— |
$93 |
— |
| CBC, automated (85027) |
— |
$77 |
— |
| Prothrombin time (PT) (85610) |
— |
$36 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$95 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$75 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$112 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$174 |
— |
| Electrocardiogram (ECG), complete (93000) |
— |
$46.25 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$4,674 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$242 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$118 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$172 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$236 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$187 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$252 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$198 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$216 |
— |