| 3D mammogram (tomosynthesis) |
— |
— |
$218 |
$51 | |
| Abdominal fluid drain (paracentesis) |
— |
— |
$679 |
$284 | |
| Achilles tendon repair |
— |
— |
$2,518 |
$624 | |
| ACL knee reconstruction |
— |
— |
$3,465 |
$889 | |
| Acupuncture |
— |
— |
$115 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$102 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$1,795 |
$204 | |
| Allergy patch testing |
— |
— |
$3,536 |
$5 | |
| Allergy shots |
— |
— |
$148 |
$11 | |
| Allergy testing |
— |
— |
$3,536 |
$4 | |
| Amniocentesis |
— |
— |
$52 |
$120 | |
| Anal fistula repair |
— |
— |
$1,570 |
$541 | |
| Ankle fracture repair |
— |
— |
$3,364 |
$608 | |
| Ankle replacement |
— |
— |
$10,385 |
$885 | |
| Annual physical (established patient) |
— |
— |
$386 |
— | |
| Annual physical (new patient) |
— |
— |
$442 |
— | |
| Anoscopy |
— |
— |
$208 |
$129 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$2,279 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$2,407 |
$1,603 | |
| Barium swallow study |
— |
— |
$239 |
$107 | |
| Benign skin lesion removal |
— |
— |
$123 |
$171 | |
| Bladder function test (urodynamics) |
— |
— |
$245 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$481 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$1,592 |
$236 | |
| Bone marrow biopsy |
— |
— |
$856 |
$172 | |
| Botox for migraine |
— |
— |
$75 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$1,974 |
$1,023 | |
| Breast biopsy |
— |
— |
$1,134 |
$478 | |
| Breast MRI |
— |
— |
$1,088 |
$216 | |
| Breast MRI without contrast |
— |
— |
$1,014 |
$216 | |
| Breast reconstruction |
— |
— |
$4,820 |
$1,227 | |
| Breast reduction |
— |
— |
$2,298 |
$980 | |
| Breast ultrasound |
— |
— |
$115 |
$92 | |
| Breast ultrasound (limited) |
— |
— |
$115 |
$84 | |
| Bronchoscopy |
— |
— |
$1,290 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$3,684 |
$883 | |
| Capsule endoscopy |
— |
— |
$1,092 |
$802 | |
| Cardiac ablation |
— |
— |
$9,941 |
$759 | |
| Cardiac catheterization |
— |
— |
$8,536 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$799 |
$170 | |
| Cardiac MRI |
— |
— |
$487 |
$322 | |
| Cardiac MRI without contrast |
— |
— |
$309 |
$280 | |
| Cardiac rehabilitation |
— |
— |
$62 |
$26 | |
| Cardiac stress test |
— |
— |
$257 |
$39 | |
| Carotid artery surgery |
— |
— |
$2,037 |
$1,026 | |
| Carpal tunnel release |
— |
— |
$1,338 |
$483 | |
| Cataract surgery |
— |
— |
$1,740 |
$547 | |
| Cervical cerclage |
— |
— |
$1,291 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$1,117 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$2,711 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$82 |
$131 | |
| Chemotherapy infusion |
— |
— |
$133 |
$81 | |
| Chemotherapy infusion (each additional) |
— |
— |
$133 |
$28 | |
| Chest fluid drain (thoracentesis) |
— |
— |
$521 |
$311 | |
| Chiropractic adjustment |
— |
— |
$96 |
$38 | |
| Circumcision |
— |
— |
$1,076 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$2,279 |
$1,238 | |
| Colostomy |
— |
— |
$2,061 |
$1,122 | |
| Colposcopy |
— |
— |
$83 |
$161 | |
| Complex wound repair |
— |
— |
$228 |
$390 | |
| Comprehensive eye exam |
— |
— |
$456 |
$138 | |
| Contact lens fitting |
— |
— |
$239 |
— | |
| Continuous glucose monitor setup |
— |
— |
$143 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$110 |
$115 | |
| Corneal transplant |
— |
— |
$2,577 |
$1,066 | |
| Coronary artery bypass (CABG) |
— |
— |
$2,895 |
$36,593 | |
| Coronary CT angiography |
— |
— |
$239 |
$326 | |
| Craniotomy (brain surgery) |
— |
— |
$3,222 |
$2,161 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$2,124 |
$835 | |
| Defibrillator (ICD) implant |
— |
— |
$22,945 |
$798 | |
| Developmental screening (child) |
— |
— |
$40 |
— | |
| Diagnostic mammogram |
— |
— |
$274 |
$140 | |
| Dialysis fistula creation |
— |
— |
$1,664 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$1,550 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$1,605 |
$745 | |
| Drug screen (urine) |
— |
— |
$18 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$143 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$421 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$2,540 |
$799 | |
| Echocardiogram |
— |
— |
$309 |
$138 | |
| Echocardiogram without contrast |
— |
— |
$309 |
$138 | |
| EEG (awake and asleep) |
— |
— |
$1,477 |
$482 | |
| Elbow replacement |
— |
— |
$10,580 |
$1,301 | |
| Electrocardiogram (EKG) |
— |
— |
$59 |
$8 | |
| Electroencephalogram (EEG) |
— |
— |
$1,379 |
$448 | |
| Electromyography (EMG) |
— |
— |
$467 |
$141 | |
| Endometrial biopsy |
— |
— |
$56 |
$98 | |
| Epidural steroid injection |
— |
— |
$538 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$1,579 |
$311 | |
| Esophageal dilation |
— |
— |
$1,029 |
$522 | |
| Esophageal variceal banding |
— |
— |
$1,029 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$78 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$1,411 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$358 |
$99 | |
| Fallopian tube X-ray (HSG) |
— |
— |
$304 |
$164 | |
| Femoral hernia repair |
— |
— |
$2,118 |
$584 | |
| Fibroid removal (myomectomy) |
— |
— |
$2,050 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$661 |
$323 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$2,195 |
$658 | |
| Ganglion cyst removal |
— |
— |
$1,179 |
$321 | |
| Glaucoma surgery |
— |
— |
$1,740 |
$984 | |
| Hammertoe repair |
— |
— |
$1,648 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$544 |
$36 | |
| Hemodialysis |
— |
— |
$382 |
$75 | |
| Hemorrhoid removal |
— |
— |
$987 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$140 |
— | |
| Hip arthroscopy |
— |
— |
$2,518 |
$931 | |
| Hip fracture repair |
— |
— |
$2,181 |
$1,120 | |
| Hip replacement |
— |
— |
$12,585 |
$1,162 | |
| Holter heart monitor |
— |
— |
$416 |
$26 | |
| Home sleep apnea test |
— |
— |
$506 |
$123 | |
| HPV vaccine |
— |
— |
$424 |
— | |
| Hydrocele repair |
— |
— |
$1,682 |
$315 | |
| Hysterectomy |
— |
— |
$5,166 |
$933 | |
| Hysteroscopy |
— |
— |
$1,635 |
$1,270 | |
| Ileostomy |
— |
— |
$1,971 |
$968 | |
| Inguinal hernia repair |
— |
— |
$1,934 |
$538 | |
| IUD insertion |
— |
— |
$161 |
— | |
| IVC filter placement |
— |
— |
$6,412 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$28 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$28 |
$56 | |
| Kidney biopsy |
— |
— |
$988 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$2,172 |
$1,164 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$1,803 |
$760 | |
| Knee arthroscopy |
— |
— |
$1,901 |
$524 | |
| Knee replacement |
— |
— |
$2,860 |
$18,054 | |
| Laminectomy (spine) |
— |
— |
$2,518 |
$1,157 | |
| Laryngoscopy |
— |
— |
$526 |
$189 | |
| Leg artery angiogram |
— |
— |
$3,941 |
$149 | |
| Leg artery angioplasty |
— |
— |
$5,352 |
— | |
| Liver biopsy |
— |
— |
$988 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$2,632 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$2,518 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$2,046 |
$750 | |
| Mastectomy |
— |
— |
$6,684 |
$1,021 | |
| Mastoidectomy |
— |
— |
$2,798 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$1,648 |
$714 | |
| Mohs skin cancer surgery |
— |
— |
$228 |
$535 | |
| MRA of the brain |
— |
— |
$487 |
$226 | |
| MRA of the brain without contrast |
— |
— |
$487 |
$328 | |
| MRI of the chest |
— |
— |
$980 |
$371 | |
| MRI of the chest with contrast |
— |
— |
$980 |
$371 | |
| MRI of the knee |
— |
— |
$980 |
$315 | |
| MRI of the knee with contrast |
— |
— |
$980 |
$315 | |
| MRI of the neck (cervical spine) |
— |
— |
$487 |
$274 | |
| MRI of the neck (cervical spine) with contrast |
— |
— |
$487 |
$274 | |
| MRI of the pelvis |
— |
— |
$487 |
$268 | |
| MRI of the pelvis with contrast |
— |
— |
$487 |
$268 | |
| MRI of the shoulder |
— |
— |
$980 |
$313 | |
| MRI of the shoulder with contrast |
— |
— |
$980 |
$313 | |
| MRI of the wrist |
— |
— |
$487 |
$330 | |
| MRI of the wrist with contrast |
— |
— |
$487 |
$330 | |
| Neck (cervical) spinal fusion |
— |
— |
$7,299 |
$1,410 | |
| Nerve conduction study |
— |
— |
$184 |
$118 | |
| Newborn hospital care |
— |
— |
$284 |
$58 | |
| Nuchal translucency ultrasound |
— |
— |
$141 |
$116 | |
| Occupational therapy evaluation |
— |
— |
$362 |
$101 | |
| Occupational therapy evaluation (high complexity) |
— |
— |
$362 |
$101 | |
| Occupational therapy evaluation (low complexity) |
— |
— |
$362 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
— |
— |
$362 |
$101 | |
| Office visit (new patient) |
— |
— |
$516 |
$177 | |
| Office visit, new patient (level 3) |
— |
— |
$305 |
$118 | |
| Office visit, new patient (level 4) |
— |
— |
$516 |
$177 | |
| Office visit, new patient (level 5) |
— |
— |
$673 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$1,505 |
$632 | |
| Ovarian cyst removal |
— |
— |
$6,493 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$2,050 |
$822 | |
| Pacemaker insertion |
— |
— |
$2,878 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$28 |
$20 | |
| Parathyroid removal |
— |
— |
$2,052 |
$891 | |
| PET scan |
— |
— |
$1,970 |
— | |
| Physical therapy evaluation |
— |
— |
$336 |
$98 | |
| Physical therapy evaluation (high complexity) |
— |
— |
$336 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
— |
— |
$336 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$1,505 |
$541 | |
| Prostate biopsy |
— |
— |
$1,335 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$2,407 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$2,217 |
$526 | |
| Pterygium removal (eye) |
— |
— |
$1,358 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$78 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$1,392 |
$462 | |
| Retina scan (OCT) |
— |
— |
$216 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$428 |
$37 | |
| Retinal detachment repair |
— |
— |
$2,319 |
$966 | |
| Rotator cuff repair |
— |
— |
$2,773 |
$792 | |
| Routine eye exam |
— |
— |
$456 |
$88 | |
| RSV vaccine |
— |
— |
$452 |
— | |
| Sacroiliac joint injection |
— |
— |
$187 |
$176 | |
| Screening mammogram |
— |
— |
$282 |
$126 | |
| Semen analysis |
— |
— |
$45 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$1,795 |
$613 | |
| Shoulder arthroscopy |
— |
— |
$2,518 |
$962 | |
| Shoulder replacement |
— |
— |
$14,479 |
$1,300 | |
| Sinus surgery (endoscopic) |
— |
— |
$1,933 |
$224 | |
| Skin biopsy |
— |
— |
$104 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$98 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$171 |
$240 | |
| Skin graft |
— |
— |
$1,757 |
$898 | |
| Sleep study (polysomnography) |
— |
— |
$1,959 |
$691 | |
| Small bowel resection |
— |
— |
$2,080 |
$1,136 | |
| Speech therapy |
— |
— |
$313 |
$76 | |
| Spinal cord stimulator |
— |
— |
$3,839 |
$2,388 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$2,518 |
$5,803 | |
| Spleen removal (splenectomy) |
— |
— |
$3,786 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$2,407 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$1,656 |
$475 | |
| Swallow study |
— |
— |
$292 |
$85 | |
| Testicle removal (orchiectomy) |
— |
— |
$1,677 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$5,494 |
$1,004 | |
| Thyroid uptake scan |
— |
— |
$514 |
$145 | |
| Tilt table test |
— |
— |
$9,036 |
$168 | |
| Tonsillectomy |
— |
— |
$2,103 |
$252 | |
| Tracheostomy |
— |
— |
$4,165 |
$273 | |
| Transesophageal echocardiogram (TEE) |
— |
— |
$653 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
— |
— |
$634 |
$239 | |
| Trigger finger release |
— |
— |
$1,179 |
$630 | |
| Trigger point injection |
— |
— |
$37 |
$56 | |
| Tubal ligation |
— |
— |
$2,069 |
$333 | |
| Turbinate reduction |
— |
— |
$1,457 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$3,972 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$1,338 |
$575 | |
| Upper GI series (barium) |
— |
— |
$239 |
$128 | |
| Ureteral stent placement |
— |
— |
$1,592 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$2,090 |
$365 | |
| UV light therapy (skin) |
— |
— |
$216 |
$106 | |
| Vaginal delivery |
— |
— |
$2,632 |
$5,487 | |
| Varicocele repair |
— |
— |
$1,930 |
$327 | |
| Varicose vein ablation |
— |
— |
$2,361 |
$1,018 | |
| Vasectomy |
— |
— |
$1,335 |
$347 | |
| Visual field test |
— |
— |
$428 |
$64 | |
| Vitrectomy (eye) |
— |
— |
$2,135 |
$814 | |
| Vocal cord injection |
— |
— |
$1,550 |
$211 | |
| Wart removal |
— |
— |
$266 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$2,878 |
$11,645 | |
| Well-child visit |
— |
— |
$305 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$4,555 |
$2,871 | |
| Wound debridement |
— |
— |
$228 |
$186 | |
| Wrist fracture repair |
— |
— |
$3,616 |
$735 | |
| YAG laser capsulotomy (eye) |
— |
— |
$434 |
$335 | |