| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$3,740 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$3,435 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$11,433 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$2,552 |
— |
| CT head/brain without contrast (70450) |
— |
$2,400 |
— |
| MRI brain without contrast (70551) |
— |
$4,500 |
— |
| MRI brain with contrast (70552) |
— |
$4,500 |
— |
| MRI brain without and with contrast (70553) |
— |
$9,000 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$713 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$4,232 |
— |
| CT pelvis with contrast (72193) |
— |
$2,767 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$4,232 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$3,825 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,338 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$881 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,224 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$823 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$823 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$781 |
— |
| Basic metabolic panel (80048) |
— |
$215 |
— |
Comprehensive metabolic panel (80053)
range across 4 matching MRF lines |
— |
$394–$584 |
— |
| Lipid panel (80061) |
— |
$272 |
— |
Renal function panel (80069)
range across 2 matching MRF lines |
— |
$207–$397 |
— |
| Hepatic function panel (80076) |
— |
$224 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$42 |
— |
| PSA, total (84153) |
— |
$337 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$393 |
— |
CBC with automated differential (85025)
range across 3 matching MRF lines |
— |
$145–$253 |
— |
| CBC, automated (85027) |
— |
$140 |
— |
| Prothrombin time (PT) (85610) |
— |
$123 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$197 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$375 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$400 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$425 |
— |
| Family psychotherapy, without patient (50 min) (90846) |
— |
$963 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$559 |
— |
| Group psychotherapy (90853) |
— |
$280 |
— |
| Left heart catheterization (93452) |
— |
$17,609 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$10,762 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$172 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$310 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$375 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$450 |
— |