| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$532 |
— |
CT head/brain without contrast (70450)
range across 3 matching MRF lines |
— |
$2,170–$2,273 |
— |
| MRI brain without contrast (70551) |
— |
$4,083 |
— |
| MRI brain with contrast (70552) |
— |
$4,731 |
— |
| MRI brain without and with contrast (70553) |
— |
$5,933 |
— |
X-ray lower spine, 4+ views (72110)
range across 2 matching MRF lines |
— |
$522–$547 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$2,942 |
— |
| CT pelvis with contrast (72193) |
— |
$2,226 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$2,673 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$3,298 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$739 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$643 |
— |
| Ultrasound, transvaginal (76830) |
— |
$634 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$436 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$559 |
— |
Mammography, screening (bilateral) (77067)
range across 3 matching MRF lines |
— |
$99–$464 |
— |
| Basic metabolic panel (80048) |
— |
$134 |
— |
| Comprehensive metabolic panel (80053) |
— |
$176 |
— |
| Obstetric panel (80055) |
— |
$776 |
— |
| Lipid panel (80061) |
— |
$133 |
— |
| Renal function panel (80069) |
— |
$146 |
— |
| Hepatic function panel (80076) |
— |
$149 |
— |
Urinalysis, non-automated, with microscopy (81000)
range across 2 matching MRF lines |
— |
$19–$47 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$22 |
— |
| PSA, total (84153) |
— |
$129 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$149 |
— |
CBC with automated differential (85025)
range across 2 matching MRF lines |
— |
$89–$90 |
— |
| CBC, automated (85027) |
— |
$85 |
— |
Prothrombin time (PT) (85610)
range across 2 matching MRF lines |
— |
$63–$64 |
— |
Partial thromboplastin time (PTT) (85730)
range across 2 matching MRF lines |
— |
$88–$93 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$210 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$255 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$339 |
— |
Sleep study (attended polysomnography) (95810)
range across 2 matching MRF lines |
— |
$2,560–$3,332 |
— |
Physical therapy, therapeutic exercise (per 15 min) (97110)
range across 6 matching MRF lines |
— |
$95–$159 |
— |
Office visit, new patient (low complexity, ~30 min) (99203)
range across 5 matching MRF lines |
— |
$150–$524 |
— |
Office visit, new patient (moderate complexity, ~45 min) (99204)
range across 5 matching MRF lines |
— |
$222–$930 |
— |
Office visit, new patient (high complexity, ~60 min) (99205)
range across 6 matching MRF lines |
— |
$263–$1,857 |
— |
| Preventive visit, new patient (age 18–39) (99385) |
— |
$186 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
— |
$191 |
— |