| Epidural injection, lumbar/sacral (with imaging) (62322) |
$306.90 |
$1,395 |
0.4× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$306.90 |
$1,395 |
0.4× |
| CT head/brain without contrast (70450) |
$272.58 |
$1,239 |
2.9× |
| MRI brain without contrast (70551) |
$262.68 |
$1,194 |
1.2× |
| MRI brain with contrast (70552) |
$310.86 |
$1,413 |
1.0× |
| MRI brain without and with contrast (70553) |
$358.82 |
$1,631 |
1.2× |
| X-ray lower spine, 4+ views (72110) |
$80.30 |
$365 |
0.9× |
| MRI lumbar spine without contrast (72148) |
$263.12 |
$1,196 |
1.2× |
| CT pelvis with contrast (72193) |
$286.88 |
$1,304 |
1.8× |
| MRI lower-extremity joint without contrast (73721) |
$275.88 |
$1,254 |
1.3× |
| CT abdomen and pelvis with contrast (74177) |
$964.48 |
$4,384 |
3.1× |
| Ultrasound, abdomen complete (76700) |
$178.64 |
$812 |
1.9× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$135.30 |
$615 |
1.5× |
| Ultrasound, transvaginal (76830) |
$125.40 |
$570 |
1.4× |
| Mammography, one breast (diagnostic) (77065) |
$83.60 |
$380 |
1.0× |
| Mammography, both breasts (diagnostic) (77066) |
$91.08 |
$414 |
0.8× |
| Mammography, screening (bilateral) (77067) |
$89.32 |
$406 |
1.0× |
| Basic metabolic panel (80048) |
$9.46 |
$43 |
1.1× |
| Comprehensive metabolic panel (80053) |
$11.66 |
$53 |
1.1× |
| Obstetric panel (80055) |
$36.08 |
$164 |
0.8× |
| Lipid panel (80061) |
$12.54 |
$57 |
0.9× |
| Renal function panel (80069) |
$36.96 |
$168 |
4.3× |
| Hepatic function panel (80076) |
$9.90 |
$45 |
1.2× |
| PSA, total (84153) |
$16.94 |
$77 |
0.9× |
| Thyroid stimulating hormone (TSH) (84443) |
$12.76 |
$58 |
0.8× |
| CBC with automated differential (85025) |
$7.04 |
$32 |
0.9× |
| CBC, automated (85027) |
$4.18 |
$19 |
0.6× |
| Prothrombin time (PT) (85610) |
$4.18 |
$19 |
1.0× |
| Partial thromboplastin time (PTT) (85730) |
$19.80 |
$90 |
3.3× |
| Group psychotherapy (90853) |
$30.58 |
$139 |
0.3× |
| Left heart catheterization (93452) |
$1,253.78 |
$5,699 |
0.4× |
| Sleep study (attended polysomnography) (95810) |
$1,147.08 |
$5,214 |
1.5× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$28.16 |
$128 |
1.0× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$48.40 |
$220 |
0.4× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$64.24 |
$292 |
0.5× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$87.78 |
$399 |
0.7× |