| Breast lesion removal (open) (19120) |
— |
$6,999 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$1,604 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$1,849 |
— |
| Diagnostic colonoscopy (45378) |
— |
$1,902 |
— |
| Colonoscopy with biopsy (45380) |
— |
$1,902 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$1,981 |
— |
| CT head/brain without contrast (70450) |
— |
$1,886 |
— |
| MRI brain without contrast (70551) |
— |
$3,864 |
— |
| MRI brain with contrast (70552) |
— |
$5,775 |
— |
| MRI brain without and with contrast (70553) |
— |
$6,468 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$1,196 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$3,864 |
— |
| CT pelvis with contrast (72193) |
— |
$3,381 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$3,864 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$6,468 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,859 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$1,615 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,229 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$656 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$1,312 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$679 |
— |
| 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) |
— |
$17 |
— |
| PSA, total (84153) |
— |
$91 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$83 |
— |
| CBC with automated differential (85025) |
— |
$39 |
— |
| CBC, automated (85027) |
— |
$32 |
— |
| Prothrombin time (PT) (85610) |
— |
$21 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$30 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$3,613 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$160 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$635 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$567 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$745 |
— |