| Breast lesion removal (open) (19120) |
— |
$1,628.75 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$1,423.84 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$2,606 |
— |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
— |
$2,280.25 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$2,290 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$2,087.55 |
— |
| Diagnostic colonoscopy (45378) |
— |
$2,070 |
— |
| Colonoscopy with biopsy (45380) |
— |
$2,020 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$1,754.16 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$1,232.34 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$2,206.50 |
— |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$3,376 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
— |
$4,674 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$250 |
— |
| CT head/brain without contrast (70450) |
— |
$1,856.18 |
— |
| MRI brain without contrast (70551) |
— |
$2,226.50 |
— |
| MRI brain with contrast (70552) |
— |
$3,411 |
— |
| MRI brain without and with contrast (70553) |
— |
$1,714 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$492.70 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$2,478 |
— |
| CT pelvis with contrast (72193) |
— |
$1,762 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$2,769.50 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$4,523 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$773.50 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$401 |
— |
| Ultrasound, transvaginal (76830) |
— |
$317 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$293.95 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$332.25 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$394.05 |
— |
| Basic metabolic panel (80048) |
— |
$483 |
— |
| Comprehensive metabolic panel (80053) |
— |
$555 |
— |
| Lipid panel (80061) |
— |
$205.50 |
— |
| Renal function panel (80069) |
— |
$158 |
— |
| Hepatic function panel (80076) |
— |
$145 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$20 |
— |
| PSA, total (84153) |
— |
$189 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$452 |
— |
| CBC with automated differential (85025) |
— |
$291 |
— |
| CBC, automated (85027) |
— |
$215 |
— |
| Prothrombin time (PT) (85610) |
— |
$114 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$192 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$263 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$206 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$302 |
— |
| Electrocardiogram (ECG), complete (93000) |
— |
$86.60 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$3,587 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$345 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$151.20 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$302.52 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$380.44 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$264 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$306 |
— |