| Breast lesion removal (open) (19120) |
— |
$2,023 |
— |
| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$1,888 |
— |
Transforaminal epidural injection, lumbar/sacral (64483)
range across 2 matching MRF lines |
— |
$1,008–$2,016 |
— |
| CT head/brain without contrast (70450) |
— |
$2,260 |
— |
| MRI brain without contrast (70551) |
— |
$3,559 |
— |
| MRI brain with contrast (70552) |
— |
$3,986 |
— |
| MRI brain without and with contrast (70553) |
— |
$4,871 |
— |
X-ray lower spine, 4+ views (72110)
range across 2 matching MRF lines |
— |
$172–$646 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$3,487 |
— |
| CT pelvis with contrast (72193) |
— |
$3,209 |
— |
MRI lower-extremity joint without contrast (73721)
range across 13 matching MRF lines |
— |
$3,396–$6,792 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$4,861 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,157 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$1,177 |
— |
Ultrasound, transvaginal (76830)
range across 3 matching MRF lines |
— |
$267–$991 |
— |
Mammography, one breast (diagnostic) (77065)
range across 8 matching MRF lines |
— |
$488–$591 |
— |
Mammography, both breasts (diagnostic) (77066)
range across 2 matching MRF lines |
— |
$781–$987 |
— |
Mammography, screening (bilateral) (77067)
range across 14 matching MRF lines |
— |
$576–$782 |
— |
| Basic metabolic panel (80048) |
— |
$30 |
— |
| Comprehensive metabolic panel (80053) |
— |
$37 |
— |
| Lipid panel (80061) |
— |
$43 |
— |
| Hepatic function panel (80076) |
— |
$14 |
— |
PSA, total (84153)
range across 2 matching MRF lines |
— |
$65–$283 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$58 |
— |
| CBC with automated differential (85025) |
— |
$27 |
— |
| CBC, automated (85027) |
— |
$14 |
— |
Prothrombin time (PT) (85610)
range across 3 matching MRF lines |
— |
$11–$13 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$126 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$186 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$186 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$186 |
— |
| Family psychotherapy, without patient (50 min) (90846) |
— |
$186 |
— |
| Family psychotherapy, with patient (50 min) (90847) |
— |
$186 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$4,317 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$167 |
— |
Office visit, new patient (low complexity, ~30 min) (99203)
range across 3 matching MRF lines |
— |
$115–$522 |
— |
Office visit, new patient (moderate complexity, ~45 min) (99204)
range across 2 matching MRF lines |
— |
$194–$324 |
— |
Office visit, new patient (high complexity, ~60 min) (99205)
range across 2 matching MRF lines |
— |
$253–$383 |
— |