| Epidural injection, lumbar/sacral (with imaging) (62322) |
$634.50 |
$1,269 |
0.8× |
| CT head/brain without contrast (70450) |
$967.50 |
$1,935 |
10.2× |
| MRI brain without contrast (70551) |
$1,663 |
$3,326 |
7.7× |
| MRI brain with contrast (70552) |
$1,848 |
$3,696 |
5.8× |
| MRI brain without and with contrast (70553) |
$2,156 |
$4,312 |
6.8× |
| X-ray lower spine, 4+ views (72110) |
$399.50 |
$799 |
4.2× |
| MRI lumbar spine without contrast (72148) |
$1,786.50 |
$3,573 |
8.3× |
| CT pelvis with contrast (72193) |
$1,736.50 |
$3,473 |
10.9× |
| MRI lower-extremity joint without contrast (73721) |
$1,848 |
$3,696 |
8.6× |
| CT abdomen and pelvis with contrast (74177) |
$2,180 |
$4,360 |
6.9× |
| Ultrasound, abdomen complete (76700) |
$682.50 |
$1,365 |
7.2× |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
$197.50 |
$395 |
2.1× |
| Ultrasound, transvaginal (76830) |
$342.50 |
$685 |
3.6× |
| Mammography, one breast (diagnostic) (77065) |
$292 |
$584 |
3.4× |
| Mammography, both breasts (diagnostic) (77066) |
$371.50 |
$743 |
3.4× |
| Mammography, screening (bilateral) (77067) |
$299.50 |
$599 |
3.3× |
| Basic metabolic panel (80048) |
$180.50 |
$361 |
21.3× |
| Comprehensive metabolic panel (80053) |
$177 |
$354 |
16.8× |
| Obstetric panel (80055) |
$229.50 |
$459 |
4.8× |
| Lipid panel (80061) |
$139 |
$278 |
10.4× |
| Renal function panel (80069) |
$151 |
$302 |
17.4× |
| Hepatic function panel (80076) |
$208 |
$416 |
25.5× |
| Urinalysis, non-automated, without microscopy (81002) |
$67.50 |
$135 |
19.4× |
| PSA, total (84153) |
$146.25 |
$292.50 |
8.0× |
| Thyroid stimulating hormone (TSH) (84443) |
$103 |
$206 |
6.1× |
| CBC with automated differential (85025) |
$82.25 |
$164.50 |
10.6× |
| CBC, automated (85027) |
$80.50 |
$161 |
12.4× |
| Prothrombin time (PT) (85610) |
$29 |
$58 |
6.8× |
| Partial thromboplastin time (PTT) (85730) |
$37 |
$74 |
6.2× |
| Psychotherapy, 30 minutes (90832) |
$158.50 |
$317 |
1.0× |
| Psychotherapy, 45 minutes (90834) |
$216 |
$432 |
1.3× |
| Psychotherapy, 60 minutes (90837) |
$180.50 |
$361 |
1.1× |
| Family psychotherapy, without patient (50 min) (90846) |
$208 |
$416 |
1.3× |
| Family psychotherapy, with patient (50 min) (90847) |
$257 |
$514 |
1.6× |
| Group psychotherapy (90853) |
$275 |
$550 |
3.0× |
| Left heart catheterization (93452) |
$9,003.50 |
$18,007 |
3.1× |
| Sleep study (attended polysomnography) (95810) |
$1,603.50 |
$3,207 |
2.1× |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
$61.50 |
$123 |
2.1× |
| Office visit, new patient (low complexity, ~30 min) (99203) |
$104.50 |
$209 |
0.9× |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
$117 |
$234 |
1.0× |
| Office visit, new patient (high complexity, ~60 min) (99205) |
$129.50 |
$259 |
1.1× |
| Office consultation (low complexity, ~30 min) (99243) |
$103 |
$206 |
0.9× |
| Office consultation (moderate complexity, ~40 min) (99244) |
$138 |
$276 |
1.1× |
| Preventive visit, new patient (age 18–39) (99385) |
$87.25 |
$174.50 |
— |
| Preventive visit, new patient (age 40–64) (99386) |
$87.25 |
$174.50 |
— |