| Breast lesion removal (open) (19120) |
— |
$13,845 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$620 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$21,245 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$3,605 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$25,110 |
— |
Inguinal hernia repair (age 5+) (49505)
range across 2 matching MRF lines |
— |
$14,000–$14,490 |
— |
| CT head/brain without contrast (70450) |
— |
$3,315 |
— |
| MRI brain without contrast (70551) |
— |
$5,250 |
— |
| MRI brain with contrast (70552) |
— |
$5,250 |
— |
| MRI brain without and with contrast (70553) |
— |
$6,145 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$685 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$5,250 |
— |
| CT pelvis with contrast (72193) |
— |
$3,350 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$5,250 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$6,695 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,185 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$1,020 |
— |
| Ultrasound, transvaginal (76830) |
— |
$700 |
— |
Mammography, one breast (diagnostic) (77065)
range across 5 matching MRF lines |
— |
$450–$615 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$450 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$450 |
— |
| Basic metabolic panel (80048) |
— |
$435 |
— |
Comprehensive metabolic panel (80053)
range across 5 matching MRF lines |
— |
$465–$565 |
— |
| Obstetric panel (80055) |
— |
$435 |
— |
| Lipid panel (80061) |
— |
$410 |
— |
| Renal function panel (80069) |
— |
$500 |
— |
| Hepatic function panel (80076) |
— |
$425 |
— |
Urinalysis, non-automated, without microscopy (81002)
range across 4 matching MRF lines |
— |
$55–$65 |
— |
PSA, total (84153)
range across 2 matching MRF lines |
— |
$220–$430 |
— |
Thyroid stimulating hormone (TSH) (84443)
range across 2 matching MRF lines |
— |
$270–$425 |
— |
| CBC with automated differential (85025) |
— |
$275 |
— |
| CBC, automated (85027) |
— |
$200 |
— |
Prothrombin time (PT) (85610)
range across 3 matching MRF lines |
— |
$125–$180 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$205 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$300 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$605 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$605 |
— |
| Group psychotherapy (90853) |
— |
$350 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$4,120 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$185 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$45 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$320 |
— |