| Epidural injection, lumbar/sacral (with imaging) (62322) |
— |
$2,432.22 |
— |
| Transforaminal epidural injection, lumbar/sacral (64483) |
— |
$3,066.26 |
— |
| CT head/brain without contrast (70450) |
— |
$2,465.06 |
— |
| MRI brain without contrast (70551) |
— |
$3,462.45 |
— |
| MRI brain with contrast (70552) |
— |
$4,993.58 |
— |
| MRI brain without and with contrast (70553) |
— |
$6,524.70 |
— |
| X-ray lower spine, 4+ views (72110) |
— |
$1,167.98 |
— |
| MRI lumbar spine without contrast (72148) |
— |
$5,963.50 |
— |
| CT pelvis with contrast (72193) |
— |
$5,592.70 |
— |
| MRI lower-extremity joint without contrast (73721) |
— |
$5,386.08 |
— |
| CT abdomen and pelvis with contrast (74177) |
— |
$7,493.14 |
— |
| Ultrasound, abdomen complete (76700) |
— |
$1,788.30 |
— |
| Ultrasound, pregnant uterus (≥14 weeks) (76805) |
— |
$810.72 |
— |
| Ultrasound, transvaginal (76830) |
— |
$1,361.42 |
— |
| Mammography, one breast (diagnostic) (77065) |
— |
$619.44 |
— |
| Mammography, both breasts (diagnostic) (77066) |
— |
$788.98 |
— |
| Mammography, screening (bilateral) (77067) |
— |
$488.06 |
— |
| Basic metabolic panel (80048) |
— |
$261.38 |
— |
| Comprehensive metabolic panel (80053) |
— |
$666.65 |
— |
| Lipid panel (80061) |
— |
$141.44 |
— |
| Renal function panel (80069) |
— |
$210.82 |
— |
| Hepatic function panel (80076) |
— |
$304.33 |
— |
| PSA, total (84153) |
— |
$122.24 |
— |
| Thyroid stimulating hormone (TSH) (84443) |
— |
$180.49 |
— |
| CBC with automated differential (85025) |
— |
$264.64 |
— |
| CBC, automated (85027) |
— |
$112.62 |
— |
| Prothrombin time (PT) (85610) |
— |
$56.41 |
— |
| Partial thromboplastin time (PTT) (85730) |
— |
$232.70 |
— |
| Psychotherapy, 30 minutes (90832) |
— |
$394.36 |
— |
| Psychotherapy, 45 minutes (90834) |
— |
$453.90 |
— |
| Psychotherapy, 60 minutes (90837) |
— |
$442.31 |
— |
| Group psychotherapy (90853) |
— |
$435.49 |
— |
| Left heart catheterization (93452) |
— |
$12,165.87 |
— |
| Sleep study (attended polysomnography) (95810) |
— |
$3,239.68 |
— |
| Physical therapy, therapeutic exercise (per 15 min) (97110) |
— |
$171.37 |
— |
| Office visit, new patient (low complexity, ~30 min) (99203) |
— |
$392.08 |
— |
| Office visit, new patient (moderate complexity, ~45 min) (99204) |
— |
$444.02 |
— |
| Office visit, new patient (high complexity, ~60 min) (99205) |
— |
$506.64 |
— |
| Office consultation (low complexity, ~30 min) (99243) |
— |
$287.60 |
— |
| Office consultation (moderate complexity, ~40 min) (99244) |
— |
$482.72 |
— |