| Breast lesion removal (open) (19120) |
— |
$6,999 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$5,191.50 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$5,983.50 |
— |
| Diagnostic colonoscopy (45378) |
— |
$14,269 |
— |
| Colonoscopy with biopsy (45380) |
— |
$6,154 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$6,411.50 |
— |
| Colonoscopy with endoscopic ultrasound (45391) |
— |
$8,963 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$1,924 |
— |
| CT head/brain without contrast (70450) |
— |
$2,099 |
— |
| MRI brain without contrast (70551) |
— |
$5,144 |
— |
| MRI brain with contrast (70552) |
— |
$7,687 |
— |
| MRI brain without and with contrast (70553) |
— |
$8,610 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$1,592 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$5,144 |
— |
| CT pelvis with contrast (72193) |
— |
$3,763 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$5,144 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$7,199 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$2,475 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$2,257.50 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,636 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$834 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$1,668 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$863 |
— |
| Basic metabolic panel (80048) |
— |
$42 |
— |
| Comprehensive metabolic panel (80053) |
— |
$52 |
— |
| Obstetric panel (80055) |
— |
$238 |
— |
| Lipid panel (80061) |
— |
$67 |
— |
| Renal function panel (80069) |
— |
$43 |
— |
| Hepatic function panel (80076) |
— |
$41 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$22.50 |
— |
| PSA, total (84153) |
— |
$91 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$83 |
— |
| CBC with automated differential (85025) |
— |
$39 |
— |
| CBC, automated (85027) |
— |
$32 |
— |
| Prothrombin time (PT) (85610) |
— |
$23.50 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$30 |
— |
| Left heart catheterization (93452) |
— |
$16,093 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$5,915 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$134 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$1,114 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$1,467 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$2,189 |
— |