| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$2,454.05 |
— |
| After-cataract laser surgery (YAG capsulotomy) (66821) |
— |
$1,645.80 |
— |
| CT head/brain without contrast (70450) |
— |
$1,771 |
— |
| MRI brain without contrast (70551) |
— |
$2,786.45 |
— |
| MRI brain with contrast (70552) |
— |
$2,947.20 |
— |
| MRI brain without and with contrast (70553) |
— |
$3,059.42 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$616.05 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$3,031.65 |
— |
| CT pelvis with contrast (72193) |
— |
$3,146 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$2,296.25 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$4,011.20 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$793.60 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$706.10 |
— |
| Ultrasound, transvaginal (76830) |
— |
$784.50 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$382.25 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$535.55 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$378.40 |
— |
| Basic metabolic panel (80048) |
— |
$48.45 |
— |
| Comprehensive metabolic panel (80053) |
— |
$80.65 |
— |
| Obstetric panel (80055) |
— |
$514.04 |
— |
| Lipid panel (80061) |
— |
$61.48 |
— |
| Renal function panel (80069) |
— |
$66.05 |
— |
| Hepatic function panel (80076) |
— |
$79.50 |
— |
| Urinalysis, non-automated, without microscopy (81002) |
— |
$19.90 |
— |
| PSA, total (84153) |
— |
$93.56 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$106.36 |
— |
| CBC with automated differential (85025) |
— |
$57.60 |
— |
| CBC, automated (85027) |
— |
$36.35 |
— |
| Prothrombin time (PT) (85610) |
— |
$30.80 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$81.12 |
— |
| Left heart catheterization (93452) |
— |
$15,428.60 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$10,063.45 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$151.90 |
— |