| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$2,209.50 |
— |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
— |
$1,645.80 |
— |
| CT head/brain without contrast (70450) |
— |
$2,335.60 |
— |
| MRI brain without contrast (70551) |
— |
$3,177.25 |
— |
| MRI brain with contrast (70552) |
— |
$3,359.55 |
— |
| MRI brain without and with contrast (70553) |
— |
$4,410.35 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$572.20 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$3,160.55 |
— |
| CT pelvis with contrast (72193) |
— |
$2,511.20 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$2,757.15 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$8,344.45 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,499.35 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$1,468.75 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,468.75 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$477.35 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$610.45 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$504.70 |
— |
| Basic metabolic panel (80048) |
— |
$74.20 |
— |
| Comprehensive metabolic panel (80053) |
— |
$92.60 |
— |
| Obstetric panel (80055) |
— |
$713.70 |
— |
| Lipid panel (80061) |
— |
$103.94 |
— |
| Renal function panel (80069) |
— |
$76.15 |
— |
| Hepatic function panel (80076) |
— |
$71.65 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$19.28 |
— |
| PSA, total (84153) |
— |
$124.13 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$115.16 |
— |
| CBC with automated differential (85025) |
— |
$68.15 |
— |
| CBC, automated (85027) |
— |
$56.75 |
— |
| Prothrombin time (PT) (85610) |
— |
$33.30 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$29.88 |
— |
| Electrocardiogram (ECG), complete (93000) |
— |
$583.50 |
— |
| Left heart catheterization (93452) |
— |
$8,443.65 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$9,506.90 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$201.50 |
— |