Pricing Transparency
Billed CPT Code Billed CPT Name Self Pay Rate

43239

UPPER GI DIAGNOSTIC WITH BIOPSY, SINGLE OR MULTIPLE

$1,581.44

91035

ESOPHAGUS REFLUX TEST WITH ELECTRODE PLACEMENT AND RECORDING

$1,450.72

45385

COLONOSCOPY WITH LESION REMOVAL BY SNARE

$1,161.60

64483

INJECTION EPIDURAL MIDDLE OR LOW SPINE

$1,171.36

64636

DESTROY MIDDLE/LOWER SPINE JOINT NERVES-ADDITIONAL JOINTS

$1,171.36

64493

JOINT INJECTION MIDDLE OR LOW SPINE-SINGLE LEVEL

$1,171.36

64494

JOINT INJECTION MIDDLE OR LOW SPINE-2ND LEVEL

$1,171.36

G0121

COLONOSCOPY - NOT HIGH RISK PERSON

$1,161.60

29823

SHOULDER ARTHROSCOPY/SURGERY, WITH REMOVAL OF DAMAGED TISSUE OR FOREIGN OBJECT, EXTENSIVE

$4,338.72

45380

COLONOSCOPY AND BIOPSY

$1,161.60

64484

SPINAL INJECTION EPIDURAL ADDITIONAL LEVELS

$1,171.36

43248

UPPER GI DIAGNOSTIC WITH INSERTION OF GUIDEWIRE AND DILATION OF ESOPHAGUS OVER GUIDEWIRE

$1,581.44

64635

DESTROY MIDDLE/LOWER SPINE JOINT NERVES-SINGLE JOINT

$1,171.36

29881

TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER

$4,338.72

43249

UPPER GI DIAGNOSTIC WITH BALLOON DILATION OF ESOPHAGUS

$1,581.44