| 3D mammogram (tomosynthesis) |
— |
— |
$31 |
$51 | |
| Abdominal fluid drain (paracentesis) |
$2,171 |
$2,171 |
$1,496 |
$284 | |
| Abdominal ultrasound |
$1,257 |
$1,257 |
$206 |
$100 | |
| Abdominal ultrasound (complete) |
$1,483 |
$1,483 |
$206 |
$114 | |
| Abdominal ultrasound (limited) |
$1,032 |
$1,032 |
$206 |
$86 | |
| Abscess drainage (complex or multiple) |
$776 |
$776 |
$582 |
$220 | |
| Abscess drainage (simple) |
$498 |
$498 |
$343 |
$129 | |
| Abscess incision and drainage |
$637 |
$637 |
$491 |
$174 | |
| Achilles tendon repair |
$22,402 |
$22,402 |
$11,584 |
$624 | |
| ACL knee reconstruction |
— |
— |
$9,832 |
$889 | |
| Acupuncture |
— |
— |
$41 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$20 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$4,425 |
$204 | |
| Albumin blood test |
$111 |
$111 |
$6 |
$5 | |
| Alkaline phosphatase test |
$37 |
$37 |
$6 |
$5 | |
| Allergy patch testing |
— |
— |
$1,437 |
$5 | |
| Allergy shots |
— |
— |
$65 |
$11 | |
| Allergy testing |
— |
— |
$1,437 |
$4 | |
| Alpha-fetoprotein (AFP) test |
$29 |
$29 |
$17 |
$17 | |
| ALT liver enzyme test |
$100 |
$100 |
$6 |
$5 | |
| Ammonia blood test |
$189 |
$189 |
$16 |
$15 | |
| Amniocentesis |
$1,508 |
$1,508 |
$1,131 |
$120 | |
| Amylase test |
$128 |
$128 |
$7 |
$6 | |
| Anal fistula repair |
— |
— |
$3,859 |
$541 | |
| Ankle fracture repair |
— |
— |
$9,832 |
$608 | |
| Ankle replacement |
— |
— |
$25,613 |
$885 | |
| Annual physical (established patient) |
— |
— |
$123 |
— | |
| Annual physical (new patient) |
— |
— |
$142 |
— | |
| Anoscopy |
$318 |
$318 |
$223 |
$129 | |
| Antinuclear antibody (ANA) test |
$24 |
$24 |
$13 |
$12 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$3,227 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$3,763 |
$1,603 | |
| Arterial blood gas (ABG) |
$909 |
$909 |
$39 |
$26 | |
| AST liver enzyme test |
$81 |
$81 |
$6 |
$5 | |
| Barium swallow study |
$1,114 |
$1,114 |
$344 |
$107 | |
| Bartholin cyst removal |
$759 |
$759 |
$373 |
$182 | |
| Basic metabolic panel |
$797 |
$797 |
$9 |
$8 | |
| Benign skin lesion removal |
$3,217 |
$3,217 |
$1,039 |
$171 | |
| Bilirubin blood test |
$7 |
$7 |
$6 |
$5 | |
| Bladder function test (urodynamics) |
— |
— |
$939 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$962 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$4,791 |
$236 | |
| Blood clotting test (PT/INR) |
$17 |
$17 |
$5 |
$4 | |
| Blood crossmatch |
$284 |
$284 |
$229 |
— | |
| Blood glucose test |
$37 |
$37 |
$5 |
$5 | |
| Blood transfusion |
$2,457 |
$2,457 |
$963 |
$47 | |
| Blood type test |
$21 |
$21 |
$91 |
$3 | |
| Blood type test (ABO group) |
$21 |
$21 |
$160 |
$3 | |
| Blood type test (Rh/D antigen) |
$107 |
$107 |
$54 |
$3 | |
| BNP (heart failure) test |
$33 |
$33 |
$39 |
$39 | |
| Bone density scan (DEXA) |
— |
— |
$151 |
$39 | |
| Bone marrow biopsy |
$5,115 |
$5,115 |
$3,523 |
$172 | |
| Bone scan (nuclear) |
$2,557 |
$2,557 |
$773 |
$259 | |
| Botox for migraine |
— |
— |
$407 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$3,270 |
$1,023 | |
| Breast biopsy |
$3,518 |
$3,518 |
$2,428 |
$478 | |
| Breast MRI |
— |
— |
$337 |
$216 | |
| Breast MRI without contrast |
— |
— |
$337 |
$216 | |
| Breast reconstruction |
— |
— |
$23,669 |
$1,227 | |
| Breast reduction |
— |
— |
$8,962 |
$980 | |
| Breast ultrasound |
$1,267 |
$1,267 |
$200 |
$92 | |
| Breast ultrasound (complete) |
$1,293 |
$1,293 |
$206 |
$100 | |
| Breast ultrasound (limited) |
$931 |
$931 |
$170 |
$84 | |
| Breathing tube insertion (intubation) |
$950 |
$950 |
$452 |
$133 | |
| Bronchoscopy |
— |
— |
$2,748 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$8,939 |
$883 | |
| Burn dressing and debridement (medium) |
$751 |
$751 |
$375 |
$166 | |
| Burn dressing and debridement (small) |
$750 |
$750 |
$375 |
$93 | |
| Burn treatment |
$750 |
$750 |
$375 |
$129 | |
| C-reactive protein (CRP) |
$7 |
$7 |
$6 |
$5 | |
| Calcium blood test |
$107 |
$107 |
$6 |
$5 | |
| Capsule endoscopy |
$3,465 |
$3,465 |
$1,640 |
$802 | |
| Cardiac ablation |
— |
— |
$32,642 |
$759 | |
| Cardiac catheterization |
— |
— |
$4,478 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$144 |
$170 | |
| Cardiac MRI |
$5,609 |
$5,609 |
$612 |
$322 | |
| Cardiac MRI without contrast |
$4,610 |
$4,610 |
$501 |
$280 | |
| Cardiac rehabilitation |
— |
— |
$182 |
$26 | |
| Cardiac stress test |
$1,517 |
$1,517 |
$578 |
$39 | |
| Cardioversion |
$3,289 |
$3,289 |
$1,220 |
$155 | |
| Carotid artery surgery |
— |
— |
$2,763 |
$1,026 | |
| Carotid artery ultrasound |
$1,904 |
$1,904 |
$397 |
$156 | |
| Carpal tunnel release |
— |
— |
$2,654 |
$483 | |
| Cataract surgery |
— |
— |
$3,203 |
$547 | |
| CEA tumor marker test |
$51 |
$51 |
$19 |
$19 | |
| Celiac disease test |
$13 |
$13 |
$12 |
$12 | |
| Central line placement |
$5,923 |
$5,923 |
$4,442 |
$238 | |
| Cervical cerclage |
— |
— |
$4,297 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$4,297 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$11,861 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$424 |
$131 | |
| Chemotherapy infusion |
— |
— |
$176 |
$81 | |
| Chemotherapy infusion (each additional) |
— |
— |
$97 |
$28 | |
| Chemotherapy infusion (first hour) |
— |
— |
$465 |
$133 | |
| Chest fluid drain (thoracentesis) |
$3,051 |
$3,051 |
$1,177 |
$311 | |
| Chest tube insertion |
$4,028 |
$4,028 |
$2,730 |
$143 | |
| Chest X-ray |
$655 |
$655 |
$182 |
$37 | |
| Chest X-ray (1 view) |
$395 |
$395 |
$170 |
$25 | |
| Chest X-ray (2 views) |
$592 |
$592 |
$170 |
$33 | |
| Chiropractic adjustment |
— |
— |
$36 |
$38 | |
| Circumcision |
— |
— |
$2,799 |
$167 | |
| Clotting time test (PTT) |
$50 |
$50 |
$8 |
$6 | |
| Colon resection (colectomy) |
— |
— |
$3,058 |
$1,238 | |
| Colonoscopy |
— |
— |
$1,548 |
$480 | |
| Colostomy |
— |
— |
$2,452 |
$1,122 | |
| Colposcopy |
— |
— |
$467 |
$161 | |
| Complete blood count (CBC) |
$189 |
$189 |
$8 |
$7 | |
| Complete blood count (CBC) (complete) |
$153 |
$153 |
$8 |
$8 | |
| Complex wound repair |
$1,630 |
$1,630 |
$1,141 |
$390 | |
| Comprehensive eye exam |
— |
— |
$182 |
$138 | |
| Comprehensive metabolic panel |
$141 |
$141 |
$16 |
$11 | |
| Contact lens fitting |
— |
— |
$37 |
— | |
| Continuous glucose monitor setup |
— |
— |
$31 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$498 |
$115 | |
| Copper blood test |
$13 |
$13 |
$12 |
$12 | |
| Corneal transplant |
— |
— |
$5,588 |
$1,066 | |
| Coronary artery bypass (CABG) |
— |
— |
$63,413 |
$36,593 | |
| Coronary CT angiography |
$1,194 |
$1,194 |
$376 |
$326 | |
| COVID-19 PCR test |
$70 |
$70 |
$56 |
$51 | |
| CPAP titration study |
$440 |
$440 |
$330 |
$69 | |
| Craniotomy (brain surgery) |
— |
— |
$3,507 |
$2,161 | |
| Creatine kinase (CK) test |
$195 |
$195 |
$7 |
$7 | |
| CT angiography of the chest |
$6,222 |
$6,222 |
$344 |
$281 | |
| CT angiography of the head |
$5,801 |
$5,801 |
$338 |
$274 | |
| CT scan of the abdomen |
$3,467 |
$3,467 |
$298 |
$230 | |
| CT scan of the abdomen and pelvis |
$7,367 |
$7,367 |
$625 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$8,860 |
$8,860 |
$721 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$7,367 |
$7,367 |
$721 |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$3,247 |
$3,247 |
$459 |
$183 | |
| CT scan of the abdomen with and without contrast |
$3,905 |
$3,905 |
$344 |
$259 | |
| CT scan of the abdomen with contrast |
$3,467 |
$3,467 |
$344 |
$230 | |
| CT scan of the abdomen without contrast |
$2,296 |
$2,296 |
$206 |
$136 | |
| CT scan of the arm |
$2,900 |
$2,900 |
$505 |
$199 | |
| CT scan of the arm with contrast |
$2,900 |
$2,900 |
$721 |
$199 | |
| CT scan of the arm without contrast |
$2,830 |
$2,830 |
$206 |
$161 | |
| CT scan of the chest |
$5,388 |
$5,388 |
$298 |
$167 | |
| CT scan of the chest with and without contrast |
$5,926 |
$5,926 |
$344 |
$196 | |
| CT scan of the chest with contrast |
$5,388 |
$5,388 |
$344 |
$167 | |
| CT scan of the chest without contrast |
$4,435 |
$4,435 |
$206 |
$133 | |
| CT scan of the head |
$4,852 |
$4,852 |
$298 |
$148 | |
| CT scan of the head with and without contrast |
$5,660 |
$5,660 |
$338 |
$173 | |
| CT scan of the head with contrast |
$4,852 |
$4,852 |
$338 |
$148 | |
| CT scan of the head without contrast |
$4,675 |
$4,675 |
$202 |
$107 | |
| CT scan of the leg |
$3,000 |
$3,000 |
$298 |
$166 | |
| CT scan of the leg with contrast |
$3,000 |
$3,000 |
$344 |
$166 | |
| CT scan of the leg without contrast |
$2,640 |
$2,640 |
$206 |
$130 | |
| CT scan of the lower back (lumbar spine) |
$5,601 |
$5,601 |
$505 |
$169 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
$5,881 |
$5,881 |
$344 |
$197 | |
| CT scan of the lower back (lumbar spine) with contrast |
$5,601 |
$5,601 |
$721 |
$169 | |
| CT scan of the lower back (lumbar spine) without contrast |
$4,973 |
$4,973 |
$206 |
$130 | |
| CT scan of the neck |
$4,697 |
$4,697 |
$298 |
$183 | |
| CT scan of the neck (cervical spine) |
$5,402 |
$5,402 |
$505 |
$168 | |
| CT scan of the neck (cervical spine) with and without contrast |
$5,538 |
$5,538 |
$344 |
$196 | |
| CT scan of the neck (cervical spine) with contrast |
$5,402 |
$5,402 |
$721 |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$4,710 |
$4,710 |
$206 |
$131 | |
| CT scan of the neck with and without contrast |
$4,932 |
$4,932 |
$338 |
$220 | |
| CT scan of the neck with contrast |
$4,697 |
$4,697 |
$338 |
$183 | |
| CT scan of the neck without contrast |
$2,997 |
$2,997 |
$202 |
$150 | |
| CT scan of the pelvis |
$3,379 |
$3,379 |
$298 |
$226 | |
| CT scan of the pelvis with and without contrast |
$3,800 |
$3,800 |
$344 |
$251 | |
| CT scan of the pelvis with contrast |
$3,379 |
$3,379 |
$344 |
$226 | |
| CT scan of the pelvis without contrast |
$2,756 |
$2,756 |
$206 |
$133 | |
| CT scan of the sinuses |
$4,320 |
$4,320 |
$282 |
$152 | |
| CT scan of the sinuses with and without contrast |
$4,788 |
$4,788 |
$338 |
$184 | |
| CT scan of the sinuses with contrast |
$4,320 |
$4,320 |
$338 |
$152 | |
| CT scan of the sinuses without contrast |
$4,128 |
$4,128 |
$206 |
$128 | |
| D-dimer test |
$14 |
$14 |
$12 |
$10 | |
| Defibrillator (ICD) implant |
— |
— |
$45,216 |
$798 | |
| Developmental screening (child) |
— |
— |
$56 |
— | |
| Diagnostic mammogram |
— |
— |
$134 |
$140 | |
| Dialysis fistula creation |
— |
— |
$4,381 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$4,297 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$3,212 |
$745 | |
| Drug screen (urine) |
$157 |
$157 |
$62 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$55 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$1,436 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$8,049 |
$799 | |
| Echocardiogram |
$3,641 |
$3,641 |
$554 |
$138 | |
| Echocardiogram with and without contrast |
$673 |
$673 |
$443 |
$101 | |
| Echocardiogram without contrast |
$3,641 |
$3,641 |
$459 |
$138 | |
| EEG (awake and asleep) |
$1,859 |
$1,859 |
$588 |
$482 | |
| EKG / ECG (tracing only) |
$461 |
$461 |
$115 |
$7 | |
| Elbow replacement |
— |
— |
$25,613 |
$1,301 | |
| Electrocardiogram (EKG) |
$461 |
$461 |
$113 |
$8 | |
| Electroencephalogram (EEG) |
$1,446 |
$1,446 |
$578 |
$448 | |
| Electrolyte panel |
$178 |
$178 |
$8 |
$7 | |
| Electromyography (EMG) |
— |
— |
$176 |
$141 | |
| Emergency department visit |
$1,780 |
$1,780 |
$609 |
$69 | |
| Emergency department visit (level 1) |
$420 |
$420 |
$166 |
$11 | |
| Emergency department visit (level 2) |
$1,230 |
$1,230 |
$307 |
$40 | |
| Emergency department visit (level 3) |
$1,780 |
$1,780 |
$535 |
$69 | |
| Emergency department visit (level 4) |
$2,930 |
$2,930 |
$830 |
$118 | |
| Emergency department visit (level 5) |
$4,420 |
$4,420 |
$1,204 |
$171 | |
| Endometrial biopsy |
— |
— |
$274 |
$98 | |
| Epidural steroid injection |
— |
— |
$968 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$5,264 |
$311 | |
| Esophageal dilation |
— |
— |
$2,031 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,615 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$8 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$2,506 |
$552 | |
| Facet joint injection (spine) |
$1,075 |
$1,075 |
$1,139 |
$99 | |
| Fallopian tube X-ray (HSG) |
$704 |
$704 |
$306 |
$164 | |
| Family therapy session |
— |
— |
$219 |
$110 | |
| Fecal occult blood (stool) test |
$49 |
$49 |
$16 |
$10 | |
| Fecal occult blood (stool) test (guaiac, gFOBT) |
$26 |
$26 |
$5 |
$4 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
$51 |
$51 |
$20 |
$16 | |
| Feeding tube (PEG) placement |
— |
— |
$2,615 |
$178 | |
| Femoral hernia repair |
— |
— |
$4,755 |
$584 | |
| Fibrinogen test |
$10 |
$10 |
$10 |
$10 | |
| Fibroid removal (myomectomy) |
— |
— |
$2,715 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$1,256 |
$323 | |
| Flu vaccine |
$67 |
$67 |
$27 |
— | |
| Folate (folic acid) test |
$58 |
$58 |
$16 |
$15 | |
| Foreign body removal (skin) |
$1,086 |
$1,086 |
$648 |
$157 | |
| Free T4 thyroid test |
$85 |
$85 |
$9 |
$9 | |
| FSH hormone test |
$19 |
$19 |
$19 |
$19 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$7,930 |
$658 | |
| Gallbladder scan (HIDA) |
$1,554 |
$1,554 |
$924 |
$334 | |
| Ganglion cyst removal |
— |
— |
$2,209 |
$321 | |
| GGT liver test |
$7 |
$7 |
$7 |
$7 | |
| Glaucoma surgery |
— |
— |
$3,203 |
$984 | |
| Glucose tolerance test |
$108 |
$108 |
$17 |
$8 | |
| Group therapy session |
— |
— |
$123 |
$30 | |
| H. pylori test |
$196 |
$196 |
$72 |
$67 | |
| Hammertoe repair |
— |
— |
$4,449 |
$548 | |
| HDL cholesterol test |
$183 |
$183 |
$12 |
$8 | |
| Hearing test (audiometry) |
— |
— |
$215 |
$36 | |
| Hematocrit test |
$5 |
$5 |
$3 |
$2 | |
| Hemodialysis |
$3,389 |
$3,389 |
$1,624 |
$75 | |
| Hemoglobin A1c (diabetes test) |
$102 |
$102 |
$10 |
$10 | |
| Hemorrhoid removal |
— |
— |
$2,068 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$76 |
— | |
| Hepatitis B test |
$20 |
$20 |
$11 |
$10 | |
| Hepatitis B vaccine |
— |
— |
$77 |
— | |
| Hip arthroscopy |
— |
— |
$9,832 |
$931 | |
| Hip fracture repair |
— |
— |
$2,670 |
$1,120 | |
| Hip replacement |
— |
— |
$18,088 |
$1,162 | |
| HIV test |
$9 |
$9 |
$21 |
$19 | |
| HIV test (antibody) |
$89 |
$89 |
$18 |
$14 | |
| Holter heart monitor |
$973 |
$973 |
$186 |
$26 | |
| Home sleep apnea test |
— |
— |
$153 |
$123 | |
| HPV vaccine |
— |
— |
$297 |
— | |
| Hydrocele repair |
— |
— |
$4,755 |
$315 | |
| Hysterectomy |
— |
— |
$14,147 |
$933 | |
| Hysteroscopy |
— |
— |
$4,297 |
$1,270 | |
| Ileostomy |
— |
— |
$2,505 |
$968 | |
| Incisional hernia repair |
$10,796 |
$10,796 |
$6,478 |
— | |
| Inguinal hernia repair |
— |
— |
$4,755 |
$538 | |
| Iron blood test |
$96 |
$96 |
$10 |
$6 | |
| IUD insertion |
— |
— |
$173 |
— | |
| IUD removal |
$1,495 |
$1,495 |
$601 |
$112 | |
| IV infusion therapy |
$568 |
$568 |
$268 |
$44 | |
| IV infusion therapy (each additional) |
$326 |
$326 |
$89 |
$21 | |
| IV infusion therapy (initial) |
$811 |
$811 |
$388 |
$67 | |
| IVC filter placement |
$23,452 |
$23,452 |
$9,942 |
$1,885 | |
| Joint aspiration (small/intermediate) |
$959 |
$959 |
$492 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
$1,262 |
$1,262 |
$555 |
$57 | |
| Joint aspiration or injection (small joint) |
$656 |
$656 |
$480 |
$56 | |
| Kidney biopsy |
$3,427 |
$3,427 |
$2,532 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$3,043 |
$1,164 | |
| Kidney scan (nuclear) |
$2,359 |
$2,359 |
$1,013 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$4,791 |
$760 | |
| Kidney ultrasound |
$1,583 |
$1,583 |
$206 |
$84 | |
| Kidney ultrasound (limited) |
$1,526 |
$1,526 |
$206 |
$61 | |
| Knee arthroscopy |
— |
— |
$4,449 |
$524 | |
| Knee joint injection |
$1,340 |
$1,340 |
$555 |
$69 | |
| Knee replacement |
— |
— |
$35,715 |
$18,054 | |
| Lactate test |
$9 |
$9 |
$12 |
$12 | |
| Laminectomy (spine) |
— |
— |
$9,832 |
$1,157 | |
| Laryngoscopy |
$950 |
$950 |
$570 |
$189 | |
| LDH test |
$6 |
$6 |
$6 |
$6 | |
| LDL cholesterol test |
$317 |
$317 |
$16 |
$11 | |
| Leg artery angiogram |
$5,867 |
$5,867 |
$4,401 |
$149 | |
| Leg artery angioplasty |
$23,280 |
$23,280 |
$13,133 |
— | |
| Leg vein ultrasound (Doppler) |
$1,949 |
$1,949 |
$357 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$1,048 |
$1,048 |
$202 |
$116 | |
| Lipase test |
$8 |
$8 |
$8 |
$7 | |
| Lipid (cholesterol) panel |
$531 |
$531 |
$20 |
$13 | |
| Liver biopsy |
$2,773 |
$2,773 |
$2,163 |
$288 | |
| Lumbar discectomy |
— |
— |
$9,832 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$8,025 |
$750 | |
| Lung function test (PFT) |
$624 |
$624 |
$344 |
$37 | |
| Lung scan (V/Q) |
$3,956 |
$3,956 |
$1,013 |
$291 | |
| Mastectomy |
— |
— |
$8,962 |
$1,021 | |
| Mastoidectomy |
— |
— |
$8,049 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$4,449 |
$714 | |
| MMR vaccine |
— |
— |
$97 |
— | |
| Mohs skin cancer surgery |
— |
— |
$914 |
$535 | |
| MRA of the brain |
$8,160 |
$8,160 |
$625 |
$226 | |
| MRA of the brain with contrast |
$8,160 |
$8,160 |
$721 |
$226 | |
| MRA of the brain without contrast |
$8,568 |
$8,568 |
$721 |
$328 | |
| MRA of the neck |
$5,884 |
$5,884 |
$625 |
$245 | |
| MRA of the neck with contrast |
$5,884 |
$5,884 |
$721 |
$245 | |
| MRA of the neck without contrast |
$6,178 |
$6,178 |
$721 |
$343 | |
| MRI of the abdomen |
$5,961 |
$5,961 |
$625 |
$300 | |
| MRI of the abdomen with contrast |
$5,961 |
$5,961 |
$721 |
$300 | |
| MRI of the abdomen without contrast |
$5,816 |
$5,816 |
$459 |
$194 | |
| MRI of the ankle |
$3,902 |
$3,902 |
$625 |
$261 | |
| MRI of the ankle with contrast |
$4,211 |
$4,211 |
$721 |
$261 | |
| MRI of the ankle without contrast |
$3,453 |
$3,453 |
$459 |
$222 | |
| MRI of the brain |
$7,964 |
$7,964 |
$625 |
$269 | |
| MRI of the brain with contrast |
$7,964 |
$7,964 |
$721 |
$269 | |
| MRI of the brain without contrast |
$7,585 |
$7,585 |
$459 |
$195 | |
| MRI of the chest |
$5,012 |
$5,012 |
$1,050 |
$371 | |
| MRI of the chest with contrast |
$5,012 |
$5,012 |
$1,449 |
$371 | |
| MRI of the chest without contrast |
$6,280 |
$6,280 |
$721 |
$466 | |
| MRI of the knee |
$10,105 |
$10,105 |
$1,050 |
$315 | |
| MRI of the knee with contrast |
$10,105 |
$10,105 |
$1,449 |
$315 | |
| MRI of the knee without contrast |
$6,557 |
$6,557 |
$459 |
$204 | |
| MRI of the lower back (lumbar spine) |
$5,396 |
$5,396 |
$625 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$5,396 |
$5,396 |
$721 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$3,371 |
$3,371 |
$459 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$3,966 |
$3,966 |
$625 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$4,164 |
$4,164 |
$721 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$3,966 |
$3,966 |
$721 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$3,743 |
$3,743 |
$459 |
$190 | |
| MRI of the neck (cervical spine) |
$4,202 |
$4,202 |
$625 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$4,412 |
$4,412 |
$721 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$4,202 |
$4,202 |
$721 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$3,341 |
$3,341 |
$459 |
$191 | |
| MRI of the pelvis |
$3,416 |
$3,416 |
$625 |
$268 | |
| MRI of the pelvis with contrast |
$3,416 |
$3,416 |
$721 |
$268 | |
| MRI of the pelvis without contrast |
$2,758 |
$2,758 |
$459 |
$227 | |
| MRI of the shoulder |
$6,050 |
$6,050 |
$1,050 |
$313 | |
| MRI of the shoulder with contrast |
$7,470 |
$7,470 |
$1,449 |
$313 | |
| MRI of the shoulder without contrast |
$3,628 |
$3,628 |
$459 |
$205 | |
| MRI of the wrist |
$6,737 |
$6,737 |
$625 |
$330 | |
| MRI of the wrist with contrast |
$6,737 |
$6,737 |
$721 |
$330 | |
| MRI of the wrist without contrast |
$3,810 |
$3,810 |
$459 |
$303 | |
| Nebulizer breathing treatment |
$339 |
$339 |
$271 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$18,088 |
$1,410 | |
| Nerve conduction study |
— |
— |
$392 |
$118 | |
| Newborn hospital care |
— |
— |
$182 |
$58 | |
| Nuchal translucency ultrasound |
$509 |
$509 |
$206 |
$116 | |
| Nuclear cardiac stress test |
$4,271 |
$4,271 |
$2,569 |
$428 | |
| Occupational therapy evaluation |
$715 |
$715 |
$169 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$843 |
$843 |
$169 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$511 |
$511 |
$184 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$715 |
$715 |
$184 |
$101 | |
| Office visit (established patient) |
$426 |
$426 |
$267 |
$115 | |
| Office visit (new patient) |
$675 |
$675 |
$315 |
$177 | |
| Office visit, established patient (level 3) |
$388 |
$388 |
$248 |
$95 | |
| Office visit, established patient (level 4) |
$464 |
$464 |
$296 |
$136 | |
| Office visit, new patient (level 3) |
$374 |
$374 |
$239 |
$118 | |
| Office visit, new patient (level 4) |
$675 |
$675 |
$431 |
$177 | |
| Office visit, new patient (level 5) |
$735 |
$735 |
$470 |
$237 | |
| Orthopedic hardware removal |
$6,878 |
$6,878 |
$4,601 |
$632 | |
| Ovarian cyst removal |
— |
— |
$6,836 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$2,724 |
$822 | |
| Pacemaker insertion |
— |
— |
$29,923 |
$15,506 | |
| Pap smear (cervical screening) |
$135 |
$135 |
$36 |
$20 | |
| Parathyroid hormone (PTH) test |
$57 |
$57 |
$41 |
$41 | |
| Parathyroid removal |
— |
— |
$8,049 |
$891 | |
| Pelvic ultrasound |
$1,166 |
$1,166 |
$206 |
$78 | |
| Pelvic ultrasound (complete) |
$1,206 |
$1,206 |
$206 |
$105 | |
| Pelvic ultrasound (limited) |
$1,126 |
$1,126 |
$206 |
$51 | |
| PET scan |
— |
— |
$2,160 |
— | |
| Phosphorus blood test |
$200 |
$200 |
$5 |
$5 | |
| Physical therapy evaluation |
$669 |
$669 |
$167 |
$98 | |
| Physical therapy evaluation (high complexity) |
$792 |
$792 |
$167 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$669 |
$669 |
$182 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$3,905 |
$541 | |
| Platelet count |
$124 |
$124 |
$6 |
$4 | |
| Pneumonia vaccine |
$109 |
$109 |
$131 |
— | |
| Pregnancy blood test (hCG) |
$118 |
$118 |
$8 |
$8 | |
| Pregnancy ultrasound |
$1,177 |
$1,177 |
$206 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$1,020 |
$1,020 |
$206 |
$117 | |
| Pregnancy ultrasound (second or third trimester) |
$1,334 |
$1,334 |
$206 |
$136 | |
| Procalcitonin test |
$138 |
$138 |
$41 |
$27 | |
| Prolactin test |
$11 |
$11 |
$19 |
$19 | |
| Prostate biopsy |
$6,060 |
$6,060 |
$3,308 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$14,147 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$7,112 |
$526 | |
| Prostate test (PSA) |
$11 |
$11 |
$18 |
$18 | |
| Psychiatric evaluation |
$474 |
$474 |
$258 |
$188 | |
| Psychotherapy session |
— |
— |
$219 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$3,212 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$84 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$2,654 |
$462 | |
| Retina scan (OCT) |
— |
— |
$84 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$176 |
$37 | |
| Retinal detachment repair |
— |
— |
$5,588 |
$966 | |
| Rheumatoid factor test |
$81 |
$81 |
$9 |
$6 | |
| Rotator cuff repair |
— |
— |
$9,832 |
$792 | |
| Routine eye exam |
— |
— |
$182 |
$88 | |
| RSV vaccine |
— |
— |
$305 |
— | |
| Sacroiliac joint injection |
$3,616 |
$3,616 |
$2,170 |
$176 | |
| Scoliosis spine X-ray |
$718 |
$718 |
$200 |
$58 | |
| Scoliosis spine X-ray (1 view) |
$594 |
$594 |
$170 |
$44 | |
| Scoliosis spine X-ray (3 views) |
$842 |
$842 |
$206 |
$72 | |
| Screening colonoscopy |
$2,624 |
$2,624 |
$1,683 |
$378 | |
| Screening mammogram |
— |
— |
$121 |
$126 | |
| Scrotal ultrasound |
$1,202 |
$1,202 |
$206 |
$99 | |
| Sedimentation rate (ESR) test |
$61 |
$61 |
$4 |
$3 | |
| Semen analysis |
— |
— |
$13 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$4,425 |
$613 | |
| Sex hormone binding globulin test |
$29 |
$29 |
$23 |
$22 | |
| Shingles vaccine |
— |
— |
$206 |
— | |
| Shoulder arthroscopy |
— |
— |
$9,832 |
$962 | |
| Shoulder replacement |
— |
— |
$25,613 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
$452 |
$452 |
$324 |
$114 | |
| Simple wound stitches |
$487 |
$487 |
$325 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$8,552 |
$224 | |
| Skin biopsy |
$1,257 |
$1,257 |
$721 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$548 |
$121 | |
| Skin cancer lesion removal |
$2,616 |
$2,616 |
$1,139 |
$240 | |
| Skin graft |
— |
— |
$4,085 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$275 |
$36 | |
| Skin tag removal |
$434 |
$434 |
$324 |
$92 | |
| Sleep study (polysomnography) |
— |
— |
$1,437 |
$691 | |
| Small bowel resection |
— |
— |
$2,824 |
$1,136 | |
| Soft tissue ultrasound |
$545 |
$545 |
$206 |
$64 | |
| Speech therapy |
$307 |
$307 |
$126 |
$76 | |
| Spinal cord stimulator |
— |
— |
$9,400 |
$2,388 | |
| Spinal tap (lumbar puncture) |
$1,224 |
$1,224 |
$950 |
$165 | |
| Spine fracture repair (kyphoplasty) |
$11,979 |
$11,979 |
$9,385 |
$5,803 | |
| Spirometry (lung function test) |
$431 |
$431 |
$283 |
$30 | |
| Spirometry with bronchodilator |
$818 |
$818 |
$554 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$13,826 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$3,021 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$4,758 |
$475 | |
| Strep throat test |
$11 |
$11 |
$17 |
$17 | |
| Stress echocardiogram |
$2,699 |
$2,699 |
$893 |
$209 | |
| Stress echocardiogram (complete) |
— |
— |
$758 |
$233 | |
| Swallow study |
$867 |
$867 |
$139 |
$85 | |
| T3 thyroid test |
$66 |
$66 |
$14 |
$14 | |
| Tdap (tetanus) vaccine |
$128 |
$128 |
$70 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$4,791 |
$306 | |
| Testosterone test |
$15 |
$15 |
$26 |
$26 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$7,989 |
$1,004 | |
| Thyroid test (TSH) |
$186 |
$186 |
$17 |
$17 | |
| Thyroid ultrasound |
$1,972 |
$1,972 |
$206 |
$109 | |
| Thyroid uptake scan |
$1,014 |
$1,014 |
$690 |
$145 | |
| Tilt table test |
— |
— |
$737 |
$168 | |
| Tonsillectomy |
— |
— |
$7,119 |
$252 | |
| Total IgE allergy test |
$9 |
$9 |
$16 |
$16 | |
| Total protein test |
$8 |
$8 |
$4 |
$4 | |
| Tracheostomy |
— |
— |
$4,425 |
$273 | |
| Transesophageal echocardiogram (TEE) |
$3,549 |
$3,549 |
$877 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
$3,549 |
$3,549 |
$1,034 |
$239 | |
| Transvaginal ultrasound |
$846 |
$846 |
$206 |
$118 | |
| Trigger finger release |
— |
— |
$2,209 |
$630 | |
| Trigger point injection |
$614 |
$614 |
$463 |
$56 | |
| Trigger point injection (1-2 muscles) |
$656 |
$656 |
$480 |
$52 | |
| Troponin (heart) test |
$332 |
$332 |
$13 |
$12 | |
| Tubal ligation |
— |
— |
$7,930 |
$333 | |
| Turbinate reduction |
— |
— |
$4,425 |
$294 | |
| Turning a breech baby (version) |
$7,156 |
$7,156 |
$5,009 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$2,654 |
$575 | |
| Upper GI endoscopy (EGD) |
— |
— |
$1,246 |
$371 | |
| Upper GI series (barium) |
$910 |
$910 |
$298 |
$128 | |
| Ureteral stent placement |
— |
— |
$4,791 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$7,112 |
$365 | |
| Uric acid (gout) test |
$75 |
$75 |
$5 |
$5 | |
| Urinalysis |
$63 |
$63 |
$4 |
$3 | |
| Urine microalbumin test |
$8 |
$8 |
$6 |
$5 | |
| Urine pregnancy test |
$176 |
$176 |
$13 |
$9 | |
| UV light therapy (skin) |
— |
— |
$84 |
$106 | |
| Vaccine administration |
$151 |
$151 |
$92 |
$19 | |
| Vaccine administration (each additional) |
$114 |
$114 |
$73 |
$16 | |
| Vaginal delivery |
— |
— |
$8,763 |
$5,487 | |
| Varicocele repair |
— |
— |
$4,791 |
$327 | |
| Varicose vein ablation |
— |
— |
$4,381 |
$1,018 | |
| Vasectomy |
— |
— |
$2,799 |
$347 | |
| Visual field test |
— |
— |
$176 |
$64 | |
| Vitamin B12 test |
$63 |
$63 |
$15 |
$15 | |
| Vitrectomy (eye) |
— |
— |
$5,588 |
$814 | |
| Vocal cord injection |
— |
— |
$5,147 |
$211 | |
| Wart removal |
$677 |
$677 |
$318 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$19,880 |
$11,645 | |
| Well-child visit |
— |
— |
$118 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$3,507 |
$2,871 | |
| Wound debridement |
$1,295 |
$1,295 |
$906 |
$186 | |
| Wrist fracture repair |
— |
— |
$9,832 |
$735 | |
| X-ray of the abdomen |
$572 |
$572 |
$199 |
$36 | |
| X-ray of the ankle |
$659 |
$659 |
$170 |
$37 | |
| X-ray of the collarbone |
$662 |
$662 |
$170 |
$33 | |
| X-ray of the elbow |
$591 |
$591 |
$170 |
$33 | |
| X-ray of the facial bones |
$665 |
$665 |
$200 |
$39 | |
| X-ray of the foot |
$643 |
$643 |
$170 |
$34 | |
| X-ray of the forearm |
$679 |
$679 |
$170 |
$29 | |
| X-ray of the hand |
$855 |
$855 |
$170 |
$38 | |
| X-ray of the hip |
$449 |
$449 |
$165 |
$49 | |
| X-ray of the hip (1 view) |
$354 |
$354 |
$166 |
$34 | |
| X-ray of the hip (3 views) |
$544 |
$544 |
$170 |
$49 | |
| X-ray of the hip (4 views) |
— |
— |
$151 |
$63 | |
| X-ray of the knee |
$541 |
$541 |
$199 |
$42 | |
| X-ray of the knee (2 views) |
$456 |
$456 |
$170 |
$34 | |
| X-ray of the knee (3 views) |
$541 |
$541 |
$170 |
$42 | |
| X-ray of the knee (4+ views) |
$1,001 |
$1,001 |
$206 |
$49 | |
| X-ray of the lower back (lumbar spine) |
$1,111 |
$1,111 |
$206 |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$879 |
$879 |
$206 |
$40 | |
| X-ray of the lower back (lumbar spine) (4+ views) |
$1,343 |
$1,343 |
$206 |
$53 | |
| X-ray of the lower leg |
$541 |
$541 |
$170 |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$797 |
$797 |
$206 |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$730 |
$730 |
$206 |
$33 | |
| X-ray of the mid-back (thoracic spine) (3 views) |
$865 |
$865 |
$206 |
$39 | |
| X-ray of the neck (cervical spine) |
$928 |
$928 |
$199 |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$720 |
$720 |
$170 |
$40 | |
| X-ray of the pelvis |
$763 |
$763 |
$206 |
$36 | |
| X-ray of the pelvis (1 view) |
$525 |
$525 |
$206 |
$28 | |
| X-ray of the ribs |
$907 |
$907 |
$204 |
$42 | |
| X-ray of the ribs (2 views) |
$800 |
$800 |
$170 |
$36 | |
| X-ray of the ribs (3 views) |
$907 |
$907 |
$206 |
$42 | |
| X-ray of the shoulder |
$916 |
$916 |
$170 |
$36 | |
| X-ray of the skull |
$662 |
$662 |
$206 |
$40 | |
| X-ray of the upper arm |
$547 |
$547 |
$170 |
$32 | |
| X-ray of the wrist |
$629 |
$629 |
$170 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$846 |
$335 | |
| Zinc blood test |
$13 |
$13 |
$11 |
$11 | |