| Epidural injection, lumbar/sacral (with imaging) (62322) |
$160 |
$800 |
0.2× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$405.60 |
$2,028 |
0.5× |
| CT head/brain without contrast (70450) |
$630.40 |
$3,152 |
6.6× |
| MRI brain without contrast (70551) |
$802.40 |
$4,012 |
3.7× |
| MRI brain with contrast (70552) |
$825.40 |
$4,127 |
2.6× |
| MRI brain without and with contrast (70553) |
$960.40 |
$4,802 |
3.0× |
| X-ray lower spine, 4+ views (72110) |
$145.20 |
$726 |
1.5× |
| MRI lumbar spine without contrast (72148) |
$566.90 |
$2,834.50 |
2.6× |
| CT pelvis with contrast (72193) |
$738.60 |
$3,693 |
4.6× |
| MRI lower-extremity joint without contrast (73721) |
$802.40 |
$4,012 |
3.7× |
| CT abdomen and pelvis with contrast (74177) |
$1,478.20 |
$7,391 |
4.7× |
| Ultrasound, abdomen complete (76700) |
$242.40 |
$1,212 |
2.6× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$242.40 |
$1,212 |
2.6× |
| Ultrasound, transvaginal (76830) |
$232.40 |
$1,162 |
2.5× |
| Mammography, one breast (diagnostic) (77065) |
$116.30 |
$581.50 |
1.3× |
| Mammography, both breasts (diagnostic) (77066) |
$148.60 |
$743 |
1.3× |
| Mammography, screening (bilateral) (77067) |
$109.20 |
$546 |
1.2× |
| Basic metabolic panel (80048) |
$104.60 |
$523 |
12.4× |
| Comprehensive metabolic panel (80053) |
$122.40 |
$612 |
11.6× |
| Lipid panel (80061) |
$96.40 |
$482 |
7.2× |
| Renal function panel (80069) |
$101 |
$505 |
11.6× |
| Hepatic function panel (80076) |
$89.40 |
$447 |
10.9× |
| Urinalysis, non-automated, without microscopy (81002) |
$17.40 |
$87 |
5.0× |
| PSA, total (84153) |
$74.60 |
$373 |
4.1× |
| Thyroid stimulating hormone (TSH) (84443) |
$27.10 |
$135.50 |
1.6× |
| CBC with automated differential (85025) |
$32.80 |
$164 |
4.2× |
| CBC, automated (85027) |
$28.20 |
$141 |
4.4× |
| Prothrombin time (PT) (85610) |
$25.20 |
$126 |
5.9× |
| Partial thromboplastin time (PTT) (85730) |
$26 |
$130 |
4.3× |
| Group psychotherapy (90853) |
$55.80 |
$279 |
0.6× |
| Left heart catheterization (93452) |
$2,749.80 |
$13,749 |
0.9× |
| Sleep study (attended polysomnography) (95810) |
$839 |
$4,195 |
1.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$36.40 |
$182 |
1.3× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$75 |
$375 |
0.6× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$89.80 |
$449 |
0.7× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$134.60 |
$673 |
1.1× |