| Breast lesion removal (open) (19120) |
— |
$8,985 |
— |
| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$2,739 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$2,515 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$1,558 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$3,117 |
— |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
— |
$5,533 |
— |
| CT head/brain without contrast (70450) |
— |
$5,143 |
— |
| MRI brain without contrast (70551) |
— |
$8,841 |
— |
| MRI brain with contrast (70552) |
— |
$10,606 |
— |
| MRI brain without and with contrast (70553) |
— |
$11,787 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$1,431 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$8,841 |
— |
| CT pelvis with contrast (72193) |
— |
$5,968 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$11,003 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$5,968 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,624 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$1,693 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,122 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$1,454 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$1,813 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$1,260 |
— |
Basic metabolic panel (80048)
range across 2 matching MRF lines |
— |
$158–$182 |
— |
| Comprehensive metabolic panel (80053) |
— |
$188 |
— |
| Lipid panel (80061) |
— |
$237 |
— |
| Renal function panel (80069) |
— |
$188 |
— |
| Hepatic function panel (80076) |
— |
$150 |
— |
| Urinalysis, non-automated, with microscopy (81000) |
— |
$215 |
— |
Urinalysis, non-automated, without microscopy (81002)
range across 3 matching MRF lines |
— |
$32–$98 |
— |
PSA, total (84153)
range across 2 matching MRF lines |
— |
$173–$231 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$440 |
— |
| CBC with automated differential (85025) |
— |
$229 |
— |
| CBC, automated (85027) |
— |
$144 |
— |
| Prothrombin time (PT) (85610) |
— |
$111 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$119 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$595 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$878 |
— |
Psychotherapy, 60 minutes (90837)
range across 3 matching MRF lines |
— |
$545–$1,091 |
— |
| Family psychotherapy, without patient (50 min) (90846) |
— |
$1,159 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$1,153 |
— |
Group psychotherapy (90853)
range across 3 matching MRF lines |
— |
$251–$545 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$8,810 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$354 |
— |
Office visit, new patient (low complexity, ~30 min) (99203)
range across 5 matching MRF lines |
— |
$746–$857 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$1,056 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$1,234 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$799 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$967 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$1,186 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$943 |
— |