| Breast lesion removal (open) (19120) |
— |
$21,176.78 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$2,000 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$13,808.71 |
— |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
— |
$39,498.69 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$13,132.78 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$13,950.89 |
— |
| Diagnostic colonoscopy (45378) |
— |
$13,437.06 |
— |
| Colonoscopy with biopsy (45380) |
— |
$13,976.36 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$13,733.13 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$43,277.09 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$20,915.62 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$11,976.12 |
— |
| Cataract removal with lens insertion (66984) |
— |
$10,082.57 |
— |
| CT head/brain without contrast (70450) |
— |
$275.25 |
— |
| MRI brain without contrast (70551) |
— |
$613.47 |
— |
| MRI brain with contrast (70552) |
— |
$954.33 |
— |
| MRI brain without and with contrast (70553) |
— |
$954.33 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$275.25 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$613.47 |
— |
| CT pelvis with contrast (72193) |
— |
$459.99 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$613.47 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$954.33 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$244.12 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$275.25 |
— |
| Ultrasound, transvaginal (76830) |
— |
$275.25 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$105.57 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$132.84 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$228.93 |
— |
| Basic metabolic panel (80048) |
— |
$25.38 |
— |
| Comprehensive metabolic panel (80053) |
— |
$31.68 |
— |
| Obstetric panel (80055) |
— |
$143.43 |
— |
| Lipid panel (80061) |
— |
$40.17 |
— |
| Renal function panel (80069) |
— |
$26.04 |
— |
| Hepatic function panel (80076) |
— |
$24.51 |
— |
| Urinalysis, non-automated, with microscopy (81000) |
— |
$12.06 |
— |
| PSA, total (84153) |
— |
$56.55 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$50.40 |
— |
| CBC with automated differential (85025) |
— |
$23.31 |
— |
| CBC, automated (85027) |
— |
$19.41 |
— |
| Prothrombin time (PT) (85610) |
— |
$12.87 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$18.03 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$326.01 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$80.04 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$330.93 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$330.93 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$330.93 |
— |