| Epidural injection, lumbar/sacral (with imaging) (62322) |
$1,257.40 |
$6,287 |
1.5× |
| Transforaminal epidural injection, lumbar/sacral (64483) |
$562.80 |
$2,814 |
0.7× |
| CT head/brain without contrast (70450) |
$568 |
$2,840 |
5.6× |
| MRI brain without contrast (70551) |
$496 |
$2,480 |
2.2× |
| MRI brain with contrast (70552) |
$620.20 |
$3,101 |
1.8× |
| MRI brain without and with contrast (70553) |
$775.20 |
$3,876 |
2.3× |
| X-ray lower spine, 4+ views (72110) |
$285.40 |
$1,427 |
2.8× |
| MRI lumbar spine without contrast (72148) |
$512.20 |
$2,561 |
2.2× |
| CT pelvis with contrast (72193) |
$638.40 |
$3,192 |
3.8× |
| MRI lower-extremity joint without contrast (73721) |
$445.60 |
$2,228 |
1.9× |
| CT abdomen and pelvis with contrast (74177) |
$1,979.40 |
$9,897 |
5.9× |
| Ultrasound, abdomen complete (76700) |
$525.20 |
$2,626 |
5.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$250.20 |
$1,251 |
2.5× |
| Ultrasound, transvaginal (76830) |
$398.60 |
$1,993 |
4.0× |
| Mammography, one breast (diagnostic) (77065) |
$126.60 |
$633 |
1.5× |
| Mammography, both breasts (diagnostic) (77066) |
$158.20 |
$791 |
1.4× |
| Mammography, screening (bilateral) (77067) |
$147.80 |
$739 |
1.6× |
| Basic metabolic panel (80048) |
$35 |
$175 |
4.1× |
| Comprehensive metabolic panel (80053) |
$190.60 |
$953 |
18.0× |
| Obstetric panel (80055) |
$73.60 |
$368 |
1.5× |
| Lipid panel (80061) |
$41.80 |
$209 |
3.1× |
| Renal function panel (80069) |
$19.80 |
$99 |
2.3× |
| Hepatic function panel (80076) |
$33.20 |
$166 |
4.1× |
| Urinalysis, non-automated, with microscopy (81000) |
$13.60 |
$68 |
3.4× |
| Urinalysis, non-automated, without microscopy (81002) |
$7.40 |
$37 |
2.1× |
| PSA, total (84153) |
$36.80 |
$184 |
2.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$69.40 |
$347 |
4.1× |
| CBC with automated differential (85025) |
$29.20 |
$146 |
3.8× |
| CBC, automated (85027) |
$76.20 |
$381 |
11.8× |
| Prothrombin time (PT) (85610) |
$21.60 |
$108 |
5.0× |
| Partial thromboplastin time (PTT) (85730) |
$25 |
$125 |
4.2× |
| Left heart catheterization (93452) |
$3,876.80 |
$19,384 |
1.2× |
| Sleep study (attended polysomnography) (95810) |
$2,126.60 |
$10,633 |
2.6× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$47.80 |
$239 |
1.6× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$40.80 |
$204 |
0.3× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$40.80 |
$204 |
0.3× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$40.80 |
$204 |
0.3× |