| Epidural injection, lumbar/sacral (with imaging) (62322) |
$199.68 |
$832 |
0.3× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$493.32 |
$2,055.50 |
0.6× |
| CT head/brain without contrast (70450) |
$909.36 |
$3,789 |
10.1× |
| MRI brain without contrast (70551) |
$666.48 |
$2,777 |
3.2× |
| MRI brain with contrast (70552) |
$1,111.20 |
$4,630 |
3.7× |
| MRI brain without and with contrast (70553) |
$1,217.28 |
$5,072 |
4.0× |
| X-ray lower spine, 4+ views (72110) |
$164.40 |
$685 |
1.8× |
| MRI lumbar spine without contrast (72148) |
$721.32 |
$3,005.50 |
3.5× |
| CT pelvis with contrast (72193) |
$934.32 |
$3,893 |
6.2× |
| MRI lower-extremity joint without contrast (73721) |
$1,058.40 |
$4,410 |
5.1× |
| CT abdomen and pelvis with contrast (74177) |
$1,479.60 |
$6,165 |
4.9× |
| Ultrasound, abdomen complete (76700) |
$267.36 |
$1,114 |
3.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$362.16 |
$1,509 |
4.0× |
| Ultrasound, transvaginal (76830) |
$267.36 |
$1,114 |
3.0× |
| Mammography, one breast (diagnostic) (77065) |
$94.80 |
$395 |
1.1× |
| Mammography, both breasts (diagnostic) (77066) |
$122.88 |
$512 |
1.1× |
| Mammography, screening (bilateral) (77067) |
$130.56 |
$544 |
1.4× |
| Basic metabolic panel (80048) |
$116.88 |
$487 |
13.8× |
| Comprehensive metabolic panel (80053) |
$117.36 |
$489 |
11.1× |
| Lipid panel (80061) |
$192 |
$800 |
14.3× |
| Renal function panel (80069) |
$135.36 |
$564 |
15.6× |
| Hepatic function panel (80076) |
$135.84 |
$566 |
16.6× |
| Urinalysis, non-automated, without microscopy (81002) |
$16.44 |
$68.50 |
4.7× |
| PSA, total (84153) |
$142.08 |
$592 |
7.7× |
| Thyroid stimulating hormone (TSH) (84443) |
$52.44 |
$218.50 |
3.1× |
| CBC with automated differential (85025) |
$41.04 |
$171 |
5.3× |
| CBC, automated (85027) |
$35.28 |
$147 |
5.5× |
| Prothrombin time (PT) (85610) |
$49.68 |
$207 |
11.6× |
| Partial thromboplastin time (PTT) (85730) |
$49.68 |
$207 |
8.3× |
| Psychotherapy, 30 minutes (90832) |
$58.56 |
$244 |
0.4× |
| Psychotherapy, 45 minutes (90834) |
$58.56 |
$244 |
0.4× |
| Psychotherapy, 60 minutes (90837) |
$58.56 |
$244 |
0.4× |
| Family psychotherapy, without patient (50 min) (90846) |
$58.56 |
$244 |
0.4× |
| Family psychotherapy, with patient (50 min) (90847) |
$58.56 |
$244 |
0.4× |
| Group psychotherapy (90853) |
$35.04 |
$146 |
0.4× |
| Sleep study (attended polysomnography) (95810) |
$1,282.80 |
$5,345 |
1.7× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$50.76 |
$211.50 |
1.7× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$95.52 |
$398 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$117.12 |
$488 |
1.0× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$162.96 |
$679 |
1.4× |