| Shoulder arthroscopy with decompression (29826) |
— |
$18,146.79 |
— |
| Knee arthroscopy with meniscectomy (29881) |
$3,270 |
$35,194.80 |
1.0× |
| Upper GI endoscopy (EGD), diagnostic (43235) |
$906 |
$2,487.06 |
1.0× |
| Upper GI endoscopy (EGD) with biopsy (43239) |
$906 |
$2,890 |
1.0× |
| Diagnostic colonoscopy (45378) |
$929 |
$3,188.65 |
1.0× |
| Colonoscopy with biopsy (45380) |
$1,196 |
$3,407.60 |
1.0× |
| Colonoscopy with lesion removal (45385) |
$1,196 |
$3,407.60 |
1.0× |
| Laparoscopic gallbladder removal (47562) |
$6,043 |
$26,665.15 |
1.0× |
| Inguinal hernia repair (age 5+) (49505) |
$3,579 |
$9,519 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$884 |
$12,091.70 |
1.0× |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
$549 |
$2,126.40 |
1.0× |
| CT head/brain without contrast (70450) |
$104 |
$3,000 |
1.0× |
| MRI brain without contrast (70551) |
$238 |
$4,564.32 |
1.0× |
| MRI brain with contrast (70552) |
$348 |
$7,478.91 |
1.0× |
| MRI brain without and with contrast (70553) |
$348 |
$7,478.91 |
1.0× |
| X-ray lower spine, 4+ views (72110) |
$104 |
$502.73 |
1.0× |
| MRI lumbar spine without contrast (72148) |
$238 |
$4,564.32 |
1.0× |
| CT pelvis with contrast (72193) |
$175 |
$3,568.96 |
1.0× |
| MRI lower-extremity joint without contrast (73721) |
$238 |
$4,564.32 |
1.0× |
| CT abdomen and pelvis with contrast (74177) |
$348 |
$7,478.91 |
1.0× |
| Ultrasound, abdomen complete (76700) |
$104 |
$1,910.85 |
1.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$104 |
$1,960.61 |
1.0× |
| Ultrasound, transvaginal (76830) |
$104 |
$502.73 |
1.0× |
| Mammography, one breast (diagnostic) (77065) |
$85 |
$743.80 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$110 |
$913.02 |
1.0× |
| Mammography, screening (bilateral) (77067) |
$90 |
$767.25 |
1.0× |
| Basic metabolic panel (80048) |
$8 |
$250 |
0.9× |
| Comprehensive metabolic panel (80053) |
$10 |
$350 |
0.9× |
| Lipid panel (80061) |
$13 |
$325 |
1.0× |
| Renal function panel (80069) |
$8 |
$173.60 |
0.9× |
| Hepatic function panel (80076) |
$8 |
$163.40 |
1.0× |
| PSA, total (84153) |
$18 |
$367.80 |
1.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$16 |
$336 |
1.0× |
| CBC with automated differential (85025) |
$7 |
$200 |
0.9× |
| CBC, automated (85027) |
$6 |
$175 |
0.9× |
| Prothrombin time (PT) (85610) |
$4 |
$115 |
0.9× |
| Partial thromboplastin time (PTT) (85730) |
$6 |
$175 |
1.0× |
| Left heart catheterization (93452) |
$3,240 |
$14,900.50 |
1.0× |
| Sleep study (attended polysomnography) (95810) |
$858 |
$10,678 |
1.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$29 |
$145.60 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$1,832.40 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$1,832.40 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$928.35 |
— |