| Breast lesion removal (open) (19120) |
— |
$13,686.40 |
— |
| Shoulder arthroscopy with decompression (29826) |
— |
$34,289.20 |
— |
| Knee arthroscopy with meniscectomy (29881) |
— |
$20,113.60 |
— |
| Tonsillectomy and adenoidectomy (under age 12) (42820) |
— |
$9,371.39 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$6,540.47 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$6,520.09 |
— |
| Diagnostic colonoscopy (45378) |
— |
$6,020.79 |
— |
| Colonoscopy with biopsy (45380) |
— |
$6,440.85 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$5,207.59 |
— |
| Colonoscopy with endoscopic ultrasound (45391) |
— |
$29,013.05 |
— |
| Laparoscopic gallbladder removal (47562) |
— |
$19,313.30 |
— |
| Inguinal hernia repair (age 5+) (49505) |
— |
$23,207 |
— |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$9,112.82 |
— |
| Obstetric care, cesarean delivery (global) (59510) |
— |
$21,180.31 |
— |
| Obstetric care, VBAC delivery (global) (59610) |
— |
$9,112.47 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$945 |
— |
| Cataract removal with lens insertion (66984) |
— |
$6,136.13 |
— |
| CT head/brain without contrast (70450) |
— |
$1,117 |
— |
| MRI brain without contrast (70551) |
— |
$2,925 |
— |
| MRI brain with contrast (70552) |
— |
$4,298 |
— |
| MRI brain without and with contrast (70553) |
— |
$4,853 |
— |
X-ray lower spine, 4+ views (72110)
range across 3 matching MRF lines |
— |
$86–$413 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$2,238 |
— |
| CT pelvis with contrast (72193) |
— |
$2,872 |
— |
MRI lower-extremity joint without contrast (73721)
range across 4 matching MRF lines |
— |
$430–$2,568 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$3,602 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$870 |
— |
Ultrasound, pregnant uterus (≥14 weeks) (76805)
range across 3 matching MRF lines |
— |
$317–$979 |
— |
| Ultrasound, transvaginal (76830) |
— |
$956 |
— |
| Basic metabolic panel (80048) |
— |
$80 |
— |
| Comprehensive metabolic panel (80053) |
— |
$89 |
— |
| Obstetric panel (80055) |
— |
$55 |
— |
| Lipid panel (80061) |
— |
$84 |
— |
| Renal function panel (80069) |
— |
$84 |
— |
| Hepatic function panel (80076) |
— |
$65 |
— |
| Urinalysis, non-automated, with microscopy (81000) |
— |
$22 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$19 |
— |
| PSA, total (84153) |
— |
$279 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$96 |
— |
| CBC with automated differential (85025) |
— |
$50 |
— |
| CBC, automated (85027) |
— |
$38 |
— |
| Prothrombin time (PT) (85610) |
— |
$62 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$62 |
— |
| Left heart catheterization (93452) |
— |
$9,543 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$4,062 |
— |
Physical therapy, therapeutic exercise (per 15 min) (97110)
range across 3 matching MRF lines |
— |
$107–$121 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$159 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$219 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$272 |
— |