| Breast lesion removal (open) (19120) |
— |
$1,412 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$851 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$978.50 |
— |
| Colonoscopy with biopsy (45380) |
— |
$1,115.50 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$1,297 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$3,413 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$1,986 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$3,879 |
— |
| CT head/brain without contrast (70450) |
— |
$2,638 |
— |
| MRI brain without contrast (70551) |
— |
$4,029 |
— |
| MRI brain with contrast (70552) |
— |
$4,300 |
— |
| MRI brain without and with contrast (70553) |
— |
$4,835 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$561 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$4,029 |
— |
| CT pelvis with contrast (72193) |
— |
$3,166 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$4,029 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$4,748 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$702 |
— |
| Ultrasound, transvaginal (76830) |
— |
$773 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$437 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$552 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$470 |
— |
| Basic metabolic panel (80048) |
— |
$293 |
— |
| Comprehensive metabolic panel (80053) |
— |
$231.50 |
— |
| Lipid panel (80061) |
— |
$70 |
— |
| Renal function panel (80069) |
— |
$293 |
— |
| Hepatic function panel (80076) |
— |
$137.50 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$74 |
— |
| PSA, total (84153) |
— |
$107 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$97 |
— |
| CBC with automated differential (85025) |
— |
$93.50 |
— |
| CBC, automated (85027) |
— |
$134 |
— |
| Prothrombin time (PT) (85610) |
— |
$27 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$66 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$102 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$192 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$386 |
— |
| Family psychotherapy, without patient (50 min) (90846) |
— |
$192 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$192 |
— |
| Group psychotherapy (90853) |
— |
$265 |
— |
| Electrocardiogram (ECG), complete (93000) |
— |
$110 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$2,044 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$86.50 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$169.50 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$396 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$425 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$320 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$420 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$311 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$338 |
— |