| Epidural injection, lumbar/sacral (with imaging) (62322) |
$619.60 |
$3,098 |
0.7× |
| CT head/brain without contrast (70450) |
$629.60 |
$3,148 |
6.3× |
| MRI brain without contrast (70551) |
$901.60 |
$4,508 |
3.9× |
| MRI brain with contrast (70552) |
$1,126.80 |
$5,634 |
3.4× |
| MRI brain without and with contrast (70553) |
$1,408.60 |
$7,043 |
4.2× |
| X-ray lower spine, 4+ views (72110) |
$214 |
$1,070 |
2.1× |
| MRI lumbar spine without contrast (72148) |
$931.80 |
$4,659 |
4.1× |
| CT pelvis with contrast (72193) |
$469.40 |
$2,347 |
2.8× |
| MRI lower-extremity joint without contrast (73721) |
$865.20 |
$4,326 |
3.8× |
| CT abdomen and pelvis with contrast (74177) |
$1,550.80 |
$7,754 |
4.6× |
| Ultrasound, abdomen complete (76700) |
$298.40 |
$1,492 |
3.0× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$244.60 |
$1,223 |
2.4× |
| Ultrasound, transvaginal (76830) |
$193 |
$965 |
1.9× |
| Mammography, one breast (diagnostic) (77065) |
$91.20 |
$456 |
1.1× |
| Mammography, both breasts (diagnostic) (77066) |
$114.20 |
$571 |
1.0× |
| Mammography, screening (bilateral) (77067) |
$113.60 |
$568 |
1.2× |
| Basic metabolic panel (80048) |
$30.80 |
$154 |
3.6× |
| Comprehensive metabolic panel (80053) |
$48.20 |
$241 |
4.6× |
| Obstetric panel (80055) |
$43.40 |
$217 |
0.9× |
| Lipid panel (80061) |
$22.80 |
$114 |
1.7× |
| Renal function panel (80069) |
$36.20 |
$181 |
4.2× |
| Hepatic function panel (80076) |
$42.20 |
$211 |
5.2× |
| Urinalysis, non-automated, with microscopy (81000) |
$11.40 |
$57 |
2.8× |
| Urinalysis, non-automated, without microscopy (81002) |
$9.40 |
$47 |
2.7× |
| PSA, total (84153) |
$30 |
$150 |
1.6× |
| Thyroid stimulating hormone (TSH) (84443) |
$21.60 |
$108 |
1.3× |
| CBC with automated differential (85025) |
$22 |
$110 |
2.8× |
| CBC, automated (85027) |
$66.30 |
$331.50 |
10.2× |
| Prothrombin time (PT) (85610) |
$19.60 |
$98 |
4.6× |
| Partial thromboplastin time (PTT) (85730) |
$25 |
$125 |
4.2× |
| Left heart catheterization (93452) |
$2,632 |
$13,160 |
0.8× |
| Sleep study (attended polysomnography) (95810) |
$1,634.40 |
$8,172 |
2.0× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$47.80 |
$239 |
1.6× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$82.80 |
$414 |
0.6× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$110.20 |
$551 |
0.9× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$143.80 |
$719 |
1.1× |