| Upper GI endoscopy (EGD), diagnostic (43235) |
— |
$4,235 |
— |
| Upper GI endoscopy (EGD) with biopsy (43239) |
— |
$7,008 |
— |
| Diagnostic colonoscopy (45378) |
— |
$9,186 |
— |
| Colonoscopy with biopsy (45380) |
— |
$9,530 |
— |
| Colonoscopy with lesion removal (45385) |
— |
$12,054 |
— |
| Colonoscopy with endoscopic ultrasound (45391) |
— |
$12,813 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$7,006 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$12,147 |
— |
| CT head/brain without contrast (70450) |
— |
$1,743 |
— |
| MRI brain without contrast (70551) |
— |
$3,936 |
— |
| MRI brain with contrast (70552) |
— |
$4,329 |
— |
| MRI brain without and with contrast (70553) |
— |
$12,189 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$1,277 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$4,232 |
— |
| CT pelvis with contrast (72193) |
— |
$1,145 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$7,929 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$3,512 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$2,497 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$2,108 |
— |
| Ultrasound, transvaginal (76830) |
— |
$2,617 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$1,600 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$2,004 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$1,789 |
— |
| Basic metabolic panel (80048) |
— |
$198 |
— |
| Comprehensive metabolic panel (80053) |
— |
$217 |
— |
| Lipid panel (80061) |
— |
$154 |
— |
| Renal function panel (80069) |
— |
$55 |
— |
| Hepatic function panel (80076) |
— |
$54 |
— |
| PSA, total (84153) |
— |
$136 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$174 |
— |
| CBC with automated differential (85025) |
— |
$41 |
— |
| CBC, automated (85027) |
— |
$36 |
— |
| Prothrombin time (PT) (85610) |
— |
$23 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$33 |
— |
| Left heart catheterization (93452) |
— |
$13,442 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$13,243 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$500 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$655 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$1,062 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$1,315 |
— |