| Breast lesion removal (open) (19120) |
— |
$9,175 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$2,889 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$2,889 |
— |
| Diagnostic colonoscopy (45378) |
— |
$2,313 |
— |
| Colonoscopy with endoscopic ultrasound (45391) |
— |
$3,041 |
— |
| Obstetric care, vaginal delivery (global) (59400) |
— |
$1,700 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$1,893 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$2,459 |
— |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
— |
$1,535 |
— |
| Cataract removal with lens insertion (66984) |
— |
$6,123 |
— |
| CT head/brain without contrast (70450) |
— |
$339 |
— |
| MRI brain without contrast (70551) |
— |
$705 |
— |
| MRI brain with contrast (70552) |
— |
$1,156 |
— |
| MRI brain without and with contrast (70553) |
— |
$1,156 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$327 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$705 |
— |
| CT pelvis with contrast (72193) |
— |
$551 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$705 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$1,156 |
— |
Ultrasound, abdomen complete (76700)
range across 2 matching MRF lines |
— |
$320–$339 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$339 |
— |
| Ultrasound, transvaginal (76830) |
— |
$339 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$399 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$502 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$402 |
— |
| Basic metabolic panel (80048) |
— |
$21 |
— |
| Comprehensive metabolic panel (80053) |
— |
$26 |
— |
| Obstetric panel (80055) |
— |
$119 |
— |
| Lipid panel (80061) |
— |
$33 |
— |
| Renal function panel (80069) |
— |
$78 |
— |
| Hepatic function panel (80076) |
— |
$20 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$8 |
— |
| PSA, total (84153) |
— |
$45 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$42 |
— |
| CBC with automated differential (85025) |
— |
$19 |
— |
| CBC, automated (85027) |
— |
$16 |
— |
| Prothrombin time (PT) (85610) |
— |
$10 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$15 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$397 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$397 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$397 |
— |
| Family psychotherapy, without patient (50 min) (90846) |
— |
$397 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$397 |
— |
| Group psychotherapy (90853) |
— |
$237 |
— |
| Electrocardiogram (ECG), complete (93000) |
— |
$145 |
— |
| Left heart catheterization (93452) |
— |
$8,631 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$2,752 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$89 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$479 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$503 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$528 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$479 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$528 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$358 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$358 |
— |