| Epidural injection, lumbar/sacral (with imaging) (62322) |
$199.68 |
$832 |
0.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$506.16 |
$2,109 |
0.6× |
| CT head/brain without contrast (70450) |
$758.88 |
$3,162 |
7.8× |
| MRI brain without contrast (70551) |
$628.56 |
$2,619 |
2.8× |
| MRI brain with contrast (70552) |
$1,153.20 |
$4,805 |
3.6× |
| MRI brain without and with contrast (70553) |
$1,451.28 |
$6,047 |
4.5× |
| X-ray lower spine, 4+ views (72110) |
$168.72 |
$703 |
1.7× |
| MRI lumbar spine without contrast (72148) |
$975.36 |
$4,064 |
4.4× |
| CT pelvis with contrast (72193) |
$1,067.28 |
$4,447 |
6.6× |
| MRI lower-extremity joint without contrast (73721) |
$975.36 |
$4,064 |
4.4× |
| CT abdomen and pelvis with contrast (74177) |
$1,844.88 |
$7,687 |
5.7× |
| Ultrasound, abdomen complete (76700) |
$267.36 |
$1,114 |
2.8× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$400.80 |
$1,670 |
4.1× |
| Ultrasound, transvaginal (76830) |
$230.64 |
$961 |
2.4× |
| Mammography, one breast (diagnostic) (77065) |
$95.64 |
$398.50 |
1.1× |
| Mammography, both breasts (diagnostic) (77066) |
$190.08 |
$792 |
1.7× |
| Mammography, screening (bilateral) (77067) |
$141.36 |
$589 |
1.6× |
| Basic metabolic panel (80048) |
$156.24 |
$651 |
18.5× |
| Comprehensive metabolic panel (80053) |
$207.60 |
$865 |
19.7× |
| Obstetric panel (80055) |
$38.64 |
$161 |
0.8× |
| Lipid panel (80061) |
$105.12 |
$438 |
7.9× |
| Renal function panel (80069) |
$130.56 |
$544 |
15.0× |
| Hepatic function panel (80076) |
$181.20 |
$755 |
22.2× |
| Urinalysis, non-automated, without microscopy (81002) |
$21.60 |
$90 |
6.2× |
| PSA, total (84153) |
$132 |
$550 |
7.2× |
| Thyroid stimulating hormone (TSH) (84443) |
$48.12 |
$200.50 |
2.9× |
| CBC with automated differential (85025) |
$41.04 |
$171 |
5.3× |
| CBC, automated (85027) |
$35.28 |
$147 |
5.5× |
| Prothrombin time (PT) (85610) |
$56.40 |
$235 |
13.1× |
| Partial thromboplastin time (PTT) (85730) |
$55.44 |
$231 |
9.2× |
| Sleep study (attended polysomnography) (95810) |
$1,282.80 |
$5,345 |
1.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$48.96 |
$204 |
1.7× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$93.60 |
$390 |
0.8× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$117.36 |
$489 |
1.0× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$126.24 |
$526 |
1.0× |