| Epidural injection, lumbar/sacral (with imaging) (62322) |
$850 |
$1,700 |
1.0× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$1,000 |
$2,000 |
1.2× |
| CT head/brain without contrast (70450) |
$1,200 |
$2,400 |
12.0× |
| MRI brain without contrast (70551) |
$1,575 |
$3,150 |
6.9× |
| MRI brain with contrast (70552) |
$1,975 |
$3,950 |
5.9× |
| MRI brain without and with contrast (70553) |
$2,200 |
$4,400 |
6.6× |
| X-ray lower spine, 4+ views (72110) |
$412.50 |
$825 |
4.1× |
| MRI lumbar spine without contrast (72148) |
$1,600 |
$3,200 |
7.0× |
| CT pelvis with contrast (72193) |
$1,250 |
$2,500 |
7.5× |
| MRI lower-extremity joint without contrast (73721) |
$1,750 |
$3,500 |
7.7× |
| CT abdomen and pelvis with contrast (74177) |
$2,850 |
$5,700 |
8.6× |
| Ultrasound, abdomen complete (76700) |
$750 |
$1,500 |
7.5× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$500 |
$1,000 |
5.0× |
| Ultrasound, transvaginal (76830) |
$500 |
$1,000 |
5.0× |
| Mammography, one breast (diagnostic) (77065) |
$97.50 |
$195 |
1.1× |
| Mammography, both breasts (diagnostic) (77066) |
$122.50 |
$245 |
1.1× |
| Mammography, screening (bilateral) (77067) |
$100 |
$200 |
1.1× |
| Basic metabolic panel (80048) |
$237.50 |
$475 |
28.1× |
| Comprehensive metabolic panel (80053) |
$375 |
$750 |
35.5× |
| Obstetric panel (80055) |
$216.50 |
$433 |
4.5× |
| Lipid panel (80061) |
$79.50 |
$159 |
5.9× |
| Renal function panel (80069) |
$245 |
$490 |
28.2× |
| Hepatic function panel (80076) |
$223.50 |
$447 |
27.4× |
| Urinalysis, non-automated, without microscopy (81002) |
$20.50 |
$41 |
5.9× |
| PSA, total (84153) |
$155 |
$310 |
8.4× |
| Thyroid stimulating hormone (TSH) (84443) |
$95 |
$190 |
5.7× |
| CBC with automated differential (85025) |
$125 |
$250 |
16.1× |
| CBC, automated (85027) |
$112.50 |
$225 |
17.4× |
| Prothrombin time (PT) (85610) |
$74.50 |
$149 |
17.4× |
| Partial thromboplastin time (PTT) (85730) |
$123.25 |
$246.50 |
20.5× |
| Psychotherapy, 30 minutes (90832) |
$207.50 |
$415 |
1.2× |
| Psychotherapy, 45 minutes (90834) |
$277.50 |
$555 |
1.6× |
| Psychotherapy, 60 minutes (90837) |
$277.50 |
$555 |
1.6× |
| Family psychotherapy, without patient (50 min) (90846) |
$325 |
$650 |
1.9× |
| Family psychotherapy, with patient (50 min) (90847) |
$325 |
$650 |
1.9× |
| Group psychotherapy (90853) |
$172.50 |
$345 |
1.8× |
| Left heart catheterization (93452) |
$6,750 |
$13,500 |
2.2× |
| Sleep study (attended polysomnography) (95810) |
$2,559.75 |
$5,119.50 |
3.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$87.50 |
$175 |
3.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$131.25 |
$262.50 |
1.0× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$162.50 |
$325 |
1.3× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$225 |
$450 |
1.8× |