| Removal of one or more growth from the breast; a surgical procedure on a female or male also called a mastectomy |
19120 |
$2,849.00 |
$2,136.75 |
| Removal of one or more growth from the breast; a surgical procedure on a female or male also called a mastectomy |
19120 |
$1,490.00 |
$1,117.50 |
| Removal of tonsils for children under 12 |
42820 |
$1,101.00 |
$825.75 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$2,014.00 |
$1,510.50 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,764.00 |
$1,323.00 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,663.00 |
$1,247.25 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$385.00 |
$288.75 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,018.00 |
$763.50 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$454.00 |
$340.50 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$1,285.00 |
$963.75 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$1,663.00 |
$1,247.25 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$1,764.00 |
$1,323.00 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$2,014.00 |
$1,510.50 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$2,231.00 |
$1,673.25 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$923.00 |
$692.25 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$1,151.00 |
$863.25 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$2,019.00 |
$1,514.25 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$1,104.00 |
$828.00 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$2,231.00 |
$1,673.25 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$2,019.00 |
$1,514.25 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$1,285.00 |
$963.75 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$2,112.00 |
$1,584.00 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$1,285.00 |
$963.75 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$1,255.00 |
$941.25 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$2,231.00 |
$1,673.25 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$2,019.00 |
$1,514.25 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$2,727.00 |
$2,045.25 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$682.00 |
$511.50 |
| Repair of groin hernia patient age 5 years or older without mesh |
49505 |
$7,279.00 |
$5,459.25 |
| Repair of groin hernia patient age 5 years or older without mesh |
49505 |
$473.00 |
$354.75 |
| Repair of groin hernia patient age 5 years or older without mesh |
49505 |
$1,891.00 |
$1,418.25 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$12.00 |
$9.00 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$179.00 |
$134.25 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$585.00 |
$438.75 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$1,410.00 |
$1,057.50 |
| Injection into the lower back with help of imaging of some type |
62323 |
$204.00 |
$153.00 |
| Injection into the lower back with help of imaging of some type |
62323 |
$802.00 |
$601.50 |
| Epidural steroid injections for lower back pain |
64483 |
$410.00 |
$307.50 |
| Epidural steroid injections for lower back pain |
64483 |
$1,621.00 |
$1,215.75 |
| Ear tube surgery (myringotomy) is the insertion of tube into the incision in the eardrum to allow fluid to drain out of the ear. |
69436 |
$607.00 |
$455.25 |
| Ear tube surgery (myringotomy) is the insertion of tube into the incision in the eardrum to allow fluid to drain out of the ear. |
69436 |
$1,215.00 |
$911.25 |
| CT scan of the head or brain without contrast or dye |
70450 |
$1,345.00 |
$1,008.75 |
| CT scan of the head or brain without contrast or dye |
70450 |
$750.00 |
$562.50 |
| CT scan of the head or brain without contrast or dye |
70450 |
$3,677.00 |
$1,930.42 |
| MRI scan of the brain with and without contrast |
70553 |
$6,879.00 |
$3,611.48 |
| MRI scan of the brain with and without contrast |
70553 |
$3,312.00 |
$2,484.00 |
| X-ray of the chest, 2 views |
71046 |
$539.00 |
$282.98 |
| X-ray of the chest, 2 views |
71046 |
$150.00 |
$112.50 |
| X-ray of the chest, 2 views |
71046 |
$384.00 |
$288.00 |
| X-ray of the lower spine with 4 or more views |
72110 |
$443.00 |
$332.25 |
| X-ray of the lower spine with 4 or more views |
72110 |
$905.00 |
$475.12 |
| X-ray of the lower spine with 4 or more views |
72110 |
$175.00 |
$131.25 |
| CT scan of the pelvis with contrast or dye |
72193 |
$1,974.00 |
$1,480.50 |
| CT scan of the pelvis with contrast or dye |
72193 |
$5,947.00 |
$3,122.18 |
| CT scan of the pelvis with contrast or dye |
72193 |
$1,050.00 |
$787.50 |
| CT scan of the abdomen with contrast or dye |
74160 |
$4,963.00 |
$2,605.58 |
| CT scan of the abdomen with contrast or dye |
74160 |
$1,535.00 |
$1,151.25 |
| CT scan of the abdomen with contrast or dye |
74160 |
$1,145.00 |
$858.75 |
| Ultrasound of the abdomen |
76700 |
$1,092.00 |
$819.00 |
| Ultrasound of the abdomen |
76700 |
$1,620.00 |
$850.50 |
| Ultrasound of the abdomen |
76700 |
$310.00 |
$232.50 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$1,246.00 |
$654.15 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$175.00 |
$131.25 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$1,257.00 |
$942.75 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$1,172.00 |
$879.00 |
| Mammogram of both breasts |
77067 |
$449.00 |
$336.75 |
| Mammogram of both breasts |
77067 |
$482.00 |
$361.50 |
| Mammogram of both breasts |
77067 |
$782.00 |
$410.55 |
| Basic Metabolic Panel |
80048 |
$111.00 |
$83.25 |
| Basic Metabolic Panel |
80048 |
$530.00 |
$278.25 |
| Basic Metabolic Panel |
80048 |
$27.00 |
$20.25 |
| Basic Metabolic Panel |
80048 |
$119.00 |
$89.25 |
| Comprehensive Metabolic Panel |
80053 |
$149.00 |
$111.75 |
| Comprehensive Metabolic Panel |
80053 |
$131.00 |
$98.25 |
| Comprehensive Metabolic Panel |
80053 |
$31.00 |
$23.25 |
| Comprehensive Metabolic Panel |
80053 |
$579.00 |
$303.98 |
| Lipid Panel |
80061 |
$678.00 |
$355.95 |
| Lipid Panel |
80061 |
$64.00 |
$48.00 |
| Lipid Panel |
80061 |
$227.00 |
$170.25 |
| Urinalysis, by dipstick or tablet reagent automated with microscopy |
81000 |
$26.00 |
$19.50 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$31.00 |
$23.25 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$144.00 |
$75.60 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$19.00 |
$14.25 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$18.00 |
$13.50 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$19.00 |
$14.25 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$19.00 |
$14.25 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$20.00 |
$15.00 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$34.00 |
$25.50 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$59.00 |
$44.25 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$305.00 |
$160.12 |
| Blood test that measures gases in the blood including the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery. |
82805 |
$196.00 |
$147.00 |
| Blood test that measures gases in the blood including the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery. |
82805 |
$453.00 |
$237.82 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$373.00 |
$195.82 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$87.00 |
$65.25 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$151.00 |
$113.25 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$137.00 |
$71.92 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$89.00 |
$66.75 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$107.00 |
$80.25 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$28.00 |
$21.00 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$279.00 |
$146.48 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$72.00 |
$54.00 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$254.00 |
$133.35 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$36.00 |
$27.00 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$22.00 |
$16.50 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$31.00 |
$23.25 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$34.00 |
$25.50 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$25.00 |
$18.75 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$70.00 |
$52.50 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$37.00 |
$27.75 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$39.00 |
$29.25 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$39.00 |
$29.25 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$40.00 |
$30.00 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$458.00 |
$240.45 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$35.00 |
$26.25 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$161.00 |
$120.75 |
| Ultrasound of chest to examine the heart |
93307 |
$2,077.00 |
$1,557.75 |
| Ultrasound of chest to examine the heart |
93307 |
$1,951.00 |
$1,463.25 |
| Ultrasound of chest to examine the heart |
93307 |
$315.00 |
$236.25 |
| Ultrasound of chest to examine the heart |
93307 |
$3,319.00 |
$1,742.48 |
| Ultrasound of chest to examine the heart |
93307 |
$770.00 |
$577.50 |
| Insertion of catheter into left heart for diagnosis |
93452 |
$4,385.00 |
$3,288.75 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$57.00 |
$42.75 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$228.00 |
$119.70 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$53.00 |
$39.75 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$268.00 |
$201.00 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$103.00 |
$77.25 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$125.00 |
$93.75 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$132.00 |
$99.00 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$128.00 |
$96.00 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$142.00 |
$106.50 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$126.00 |
$94.50 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$48.00 |
$36.00 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$139.00 |
$72.98 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$123.00 |
$92.25 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$169.00 |
$88.72 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$127.00 |
$95.25 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$112.00 |
$84.00 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$118.00 |
$88.50 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$256.00 |
$192.00 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$270.00 |
$202.50 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$111.00 |
$83.25 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$257.00 |
$192.75 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$184.00 |
$96.60 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$111.00 |
$83.25 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$180.00 |
$135.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$149.00 |
$111.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$187.00 |
$140.25 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$239.00 |
$179.25 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$155.00 |
$116.25 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$141.00 |
$105.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$105.00 |
$78.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$125.00 |
$93.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$161.00 |
$120.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$193.00 |
$144.75 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$140.00 |
$105.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$144.00 |
$108.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$31.00 |
$16.28 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$136.00 |
$102.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$182.00 |
$136.50 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$685.00 |
$513.75 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$276.00 |
$207.00 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$1,351.00 |
$709.28 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$190.00 |
$142.50 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$303.00 |
$227.25 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$424.00 |
$318.00 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$2,155.00 |
$1,131.38 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$325.00 |
$243.75 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$388.00 |
$291.00 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$1,338.00 |
$1,003.50 |
