| Removal of one or more growth from the breast; a surgical procedure on a female or male also called a mastectomy |
19120 |
$4,679.00 |
$2,573.45 |
| Removal of one or more growth from the breast; a surgical procedure on a female or male also called a mastectomy |
19120 |
$4,679.00 |
$2,573.45 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,758.00 |
$966.90 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,758.00 |
$966.90 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,598.00 |
$878.90 |
| Upper endoscopy; diagnostic exam to diagnose or treat conditions in the upper part of your digestive tract. |
43235 |
$1,598.00 |
$878.90 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$1,914.00 |
$1,052.70 |
| Biopsy (or surgical procedure to remove tissue) for the upper digestive tract |
43239 |
$1,914.00 |
$1,052.70 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$1,914.00 |
$1,052.70 |
| Diagnostic colonoscopy; used to diagnose abnormalities in the large intestines and rectum |
45378 |
$1,914.00 |
$1,052.70 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$1,914.00 |
$1,052.70 |
| Colonoscopy, flexible; with biopsy, single or multiple |
45380 |
$1,914.00 |
$1,052.70 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$1,914.00 |
$1,052.70 |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
45385 |
$1,914.00 |
$1,052.70 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$6,578.00 |
$3,617.90 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$1,380.00 |
$759.00 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$6,578.00 |
$3,617.90 |
| Surgical removal of the gallbladder called a laparoscopic cholecystectomy |
47562 |
$1,380.00 |
$759.00 |
| Repair of groin hernia patient age 5 years or older without mesh |
49505 |
$7,156.00 |
$3,935.80 |
| Repair of groin hernia patient age 5 years or older without mesh |
49505 |
$7,156.85 |
$3,936.27 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$699.00 |
$384.45 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$733.00 |
$403.15 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$733.00 |
$403.15 |
| Injection of substance into the lower back or lumbar spine |
62322 |
$699.00 |
$384.45 |
| Injection into the lower back with help of imaging of some type |
62323 |
$1,267.00 |
$696.85 |
| Injection into the lower back with help of imaging of some type |
62323 |
$1,267.97 |
$697.38 |
| Epidural steroid injections for lower back pain |
64483 |
$593.00 |
$326.15 |
| Epidural steroid injections for lower back pain |
64483 |
$566.00 |
$311.30 |
| Epidural steroid injections for lower back pain |
64483 |
$593.00 |
$326.15 |
| Epidural steroid injections for lower back pain |
64483 |
$566.00 |
$311.30 |
| Laser removal of cataracts in eyes |
66821 |
$1,258.00 |
$691.90 |
| Laser removal of cataracts in eyes |
66821 |
$922.00 |
$507.10 |
| Laser removal of cataracts in eyes |
66821 |
$1,258.00 |
$691.90 |
| Laser removal of cataracts in eyes |
66821 |
$922.00 |
$507.10 |
| CT scan of the head or brain without contrast or dye |
70450 |
$1,143.00 |
$628.65 |
| CT scan of the head or brain without contrast or dye |
70450 |
$1,143.00 |
$628.65 |
| MRI scan of the brain with and without contrast |
70553 |
$2,968.00 |
$1,632.40 |
| MRI scan of the brain with and without contrast |
70553 |
$2,968.00 |
$1,632.40 |
| X-ray of the chest, 2 views |
71046 |
$155.25 |
$85.39 |
| X-ray of the chest, 2 views |
71046 |
$155.00 |
$85.25 |
| X-ray of the chest, 2 views |
71046 |
$310.45 |
$170.75 |
| X-ray of the chest, 2 views |
71046 |
$310.00 |
$170.50 |
| X-ray of the lower spine with 4 or more views |
72110 |
$404.00 |
$222.20 |
| X-ray of the lower spine with 4 or more views |
72110 |
$404.00 |
$222.20 |
| CT scan of the pelvis with contrast or dye |
72193 |
$1,723.00 |
$947.65 |
| CT scan of the pelvis with contrast or dye |
72193 |
$1,723.00 |
$947.65 |
| CT scan of the abdomen with contrast or dye |
74160 |
$1,751.00 |
$963.05 |
| CT scan of the abdomen with contrast or dye |
74160 |
$1,751.00 |
$963.05 |
| Ultrasound of the abdomen |
76700 |
$613.00 |
$337.15 |
| Ultrasound of the abdomen |
76700 |
$613.00 |
$337.15 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$344.00 |
$189.20 |
| Ultrasound for pregnancy after 1st trimester or after 14 weeks for a single baby or first baby for multiples |
76805 |
$344.00 |
$189.20 |
| Mammogram of both breasts |
77067 |
$172.00 |
$94.60 |
| Mammogram of both breasts |
77067 |
$172.00 |
$94.60 |
| Mammogram of both breasts |
77067 |
$86.00 |
$47.30 |
| Mammogram of both breasts |
77067 |
$86.00 |
$47.30 |
| Basic Metabolic Panel |
80048 |
$99.00 |
$54.45 |
| Basic Metabolic Panel |
80048 |
$99.00 |
$54.45 |
| Comprehensive Metabolic Panel |
80053 |
$32.00 |
$17.60 |
| Comprehensive Metabolic Panel |
80053 |
$32.00 |
$17.60 |
| Lipid Panel |
80061 |
$85.00 |
$46.75 |
| Lipid Panel |
80061 |
$85.00 |
$46.75 |
| Urinalysis, by dipstick or tablet reagent automated with microscopy |
81000 |
$28.00 |
$15.40 |
| Urinalysis, by dipstick or tablet reagent automated with microscopy |
81000 |
$28.00 |
$15.40 |
| Urinalysis, by dipstick or tablet reagent automated with microscopy |
81000 |
$11.00 |
$6.05 |
| Urinalysis, by dipstick or tablet reagent automated with microscopy |
81000 |
$11.00 |
$6.05 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$28.00 |
$15.40 |
| Urinalysis, by dipstick or tablet reagent not automated without a microscope |
81001 |
$28.00 |
$15.40 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$19.00 |
$10.45 |
| Urinalysis, by dipstick or tablet reagent non-automated with microscopy |
81002 |
$19.00 |
$10.45 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$46.00 |
$25.30 |
| Blood test for creatine kinase level; test for heart attack, stroke and for skeletal muscular damage |
82550 |
$46.00 |
$25.30 |
| 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 |
$197.00 |
$108.35 |
| 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 |
$197.00 |
$108.35 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$117.00 |
$64.35 |
| Blood test that measures the amount of thyroid stimulating hormone (TSH). It helps determine how well your thyroid is functioning. |
84443 |
$117.00 |
$64.35 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$69.00 |
$37.95 |
| Blood test used to test Troponin levels in the blood; generally used to diagnose heart attacks |
84484 |
$69.00 |
$37.95 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$73.00 |
$40.15 |
| Complete blood cell count (red cells, white blood cell, platelets), automated test |
85025 |
$73.00 |
$40.15 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$27.00 |
$14.85 |
| Blood test for the amount of time it takes to form clots; called a Prothrombin Time (PT) test. |
85610 |
$27.00 |
$14.85 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$140.00 |
$77.00 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$140.00 |
$77.00 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$154.00 |
$84.70 |
| Routine electrocardiogram (EKG) with tracing using at least 12 leads |
93005 |
$154.00 |
$84.70 |
| Ultrasound of chest to examine the heart |
93307 |
$774.00 |
$425.70 |
| Ultrasound of chest to examine the heart |
93307 |
$774.00 |
$425.70 |
| Insertion of catheter into left heart for diagnosis |
93452 |
$5,797.00 |
$3,188.35 |
| Insertion of catheter into left heart for diagnosis |
93452 |
$5,797.00 |
$3,188.35 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$152.00 |
$83.60 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$168.00 |
$92.40 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$152.00 |
$83.60 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$160.00 |
$88.00 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$160.00 |
$88.00 |
| Treatment to relieve airway obstruction or for sputum specimen; used to relieve conditions of COPD |
94640 |
$168.00 |
$92.40 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$72.00 |
$39.60 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$75.00 |
$41.25 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$75.00 |
$41.25 |
| Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes |
97110 |
$72.00 |
$39.60 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$64.00 |
$35.20 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$67.00 |
$36.85 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$64.00 |
$35.20 |
| Training for walking to 1 or more areas for 15 minutes |
97116 |
$67.00 |
$36.85 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$87.00 |
$47.85 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$83.00 |
$45.65 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$83.00 |
$45.65 |
| Physical therapy evaluation session for 20 minutes |
97161 |
$87.00 |
$47.85 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$114.00 |
$62.70 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$114.00 |
$62.70 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$140.00 |
$77.00 |
| Office visit for an established patient (moderate severity) typically 15 minutes |
99213 |
$140.00 |
$77.00 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$320.00 |
$176.00 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$320.00 |
$176.00 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$276.00 |
$151.80 |
| Emergency department visit facility fees for a visit of moderate severity |
99283 |
$276.00 |
$151.80 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$386.00 |
$212.30 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$386.00 |
$212.30 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$482.00 |
$265.10 |
| Emergency department visit facility fees for a visit of high to moderate severity |
99284 |
$482.00 |
$265.10 |
