| 3D mammogram (tomosynthesis) |
$34 |
$68 |
— |
$51 | |
| Abdominal ultrasound |
$373 |
$746 |
— |
$100 | |
| Abdominal ultrasound (complete) |
$493 |
$985 |
— |
$114 | |
| Abdominal ultrasound (limited) |
$352 |
$703 |
— |
$86 | |
| Abscess drainage (complex or multiple) |
$341 |
$681 |
— |
$220 | |
| Abscess drainage (simple) |
$135 |
$270 |
— |
$129 | |
| Abscess incision and drainage |
$150 |
$300 |
— |
$174 | |
| Achilles tendon repair |
$797 |
$1,594 |
— |
$624 | |
| ACL knee reconstruction |
$1,077 |
$2,153 |
— |
$889 | |
| Albumin blood test |
$7 |
$14 |
$2 |
$5 | |
| Aldosterone test |
$208 |
$415 |
$20 |
$41 | |
| Alkaline phosphatase test |
$18 |
$36 |
$3 |
$5 | |
| Allergy shots |
$25 |
$50 |
— |
$11 | |
| Allergy testing |
$5 |
$9 |
— |
$4 | |
| Alpha-fetoprotein (AFP) test |
$95 |
$190 |
$8 |
$17 | |
| ALT liver enzyme test |
$41 |
$82 |
$3 |
$5 | |
| Ammonia blood test |
$30 |
$59 |
$7 |
$15 | |
| Amylase test |
$147 |
$294 |
$3 |
$6 | |
| Anal fistula repair |
$533 |
$1,065 |
— |
$541 | |
| Ankle fracture repair |
$731 |
$1,462 |
— |
$608 | |
| Ankle replacement |
$1,072 |
$2,144 |
— |
$885 | |
| Annual physical (established patient) |
$74 |
$147 |
— |
— | |
| Annual physical (new patient) |
$130 |
$259 |
— |
— | |
| Anoscopy |
$49 |
$97 |
— |
$129 | |
| Antinuclear antibody (ANA) test |
$16 |
$32 |
$6 |
$12 | |
| Aortic aneurysm repair (AAA) |
$1,949 |
$3,897 |
— |
$1,345 | |
| Arterial blood gas (ABG) |
$150 |
$300 |
$10 |
$26 | |
| AST liver enzyme test |
$41 |
$82 |
$3 |
$5 | |
| Bartholin cyst removal |
$136 |
$271 |
— |
$182 | |
| Basic metabolic panel |
$39 |
$78 |
$4 |
$8 | |
| Benign skin lesion removal |
$389 |
$777 |
— |
$171 | |
| Bilirubin blood test |
$32 |
$64 |
$2 |
$5 | |
| Bladder function test (urodynamics) |
$140 |
$281 |
— |
$345 | |
| Bladder scope (cystoscopy) |
$329 |
$659 |
— |
$216 | |
| Blood clotting test (PT/INR) |
$45 |
$90 |
$2 |
$4 | |
| Blood glucose test |
$43 |
$85 |
$2 |
$5 | |
| Blood transfusion |
$619 |
$1,238 |
— |
$47 | |
| Blood type and screen |
$89 |
$177 |
$4 |
$10 | |
| Blood type test |
$25 |
$50 |
$1 |
$3 | |
| Blood type test (ABO group) |
$36 |
$73 |
$1 |
$3 | |
| Blood type test (Rh/D antigen) |
$25 |
$50 |
$1 |
$3 | |
| BNP (heart failure) test |
$146 |
$291 |
$17 |
$39 | |
| Bone density scan (DEXA) |
$293 |
$586 |
— |
$39 | |
| Breast reduction |
$1,188 |
$2,375 |
— |
$980 | |
| Breast ultrasound |
$40 |
$80 |
— |
$92 | |
| Breast ultrasound (limited) |
$39 |
$77 |
— |
$84 | |
| Breathing tube insertion (intubation) |
$297 |
$593 |
— |
$133 | |
| Bunion surgery (bunionectomy) |
$585 |
$1,170 |
— |
$883 | |
| Burn dressing and debridement (medium) |
$124 |
$247 |
— |
$166 | |
| Burn dressing and debridement (small) |
$242 |
$484 |
— |
$93 | |
| Burn treatment |
$183 |
$366 |
— |
$129 | |
| C-reactive protein (CRP) |
$33 |
$67 |
$3 |
$5 | |
| CA 19-9 tumor marker test |
$147 |
$293 |
$10 |
$21 | |
| CA-125 ovarian marker test |
$62 |
$124 |
$10 |
$21 | |
| Calcium blood test |
$37 |
$73 |
$3 |
$5 | |
| Cardiac rehabilitation |
$124 |
$249 |
— |
$26 | |
| Cardiac stress test |
$247 |
$494 |
— |
$39 | |
| Cardioversion |
$116 |
$232 |
— |
$155 | |
| Carotid artery surgery |
$1,266 |
$2,532 |
— |
$1,026 | |
| Carotid artery ultrasound |
$599 |
$1,198 |
— |
$156 | |
| Carpal tunnel release |
$505 |
$1,009 |
— |
$483 | |
| Cataract surgery |
$658 |
$1,316 |
— |
$547 | |
| CEA tumor marker test |
$123 |
$247 |
$9 |
$19 | |
| Celiac disease test |
$54 |
$108 |
— |
$12 | |
| Central line placement |
$1,301 |
$2,602 |
— |
$238 | |
| Chalazion (eyelid cyst) removal |
$105 |
$209 |
— |
$131 | |
| Chemotherapy infusion |
$291 |
$581 |
— |
$81 | |
| Chemotherapy infusion (first hour) |
$291 |
$581 |
— |
$133 | |
| Chest tube insertion |
$192 |
$383 |
— |
$143 | |
| Chest X-ray |
$156 |
$311 |
— |
$37 | |
| Chest X-ray (1 view) |
$132 |
$264 |
— |
$25 | |
| Chest X-ray (2 views) |
$171 |
$342 |
— |
$33 | |
| Chickenpox (varicella) vaccine |
$268 |
$535 |
$345 |
— | |
| Chiropractic adjustment |
$35 |
$69 |
— |
$38 | |
| Circumcision |
$162 |
$324 |
— |
$167 | |
| CK-MB heart enzyme test |
$17 |
$33 |
$6 |
$12 | |
| Clotting time test (PTT) |
$49 |
$97 |
$3 |
$6 | |
| Colon resection (colectomy) |
$1,514 |
$3,028 |
— |
$1,238 | |
| Colonoscopy |
$229 |
$457 |
— |
$480 | |
| Colostomy |
$1,369 |
$2,738 |
— |
$1,122 | |
| Colposcopy |
$119 |
$237 |
— |
$161 | |
| Complete blood count (CBC) |
$52 |
$104 |
$4 |
$7 | |
| Complete blood count (CBC) (complete) |
$49 |
$98 |
$4 |
$8 | |
| Complex wound repair |
$254 |
$507 |
— |
$390 | |
| Comprehensive eye exam |
$86 |
$172 |
— |
$138 | |
| Comprehensive metabolic panel |
$49 |
$98 |
$5 |
$11 | |
| Continuous glucose monitor setup |
$43 |
$85 |
— |
$35 | |
| Contraceptive implant (Nexplanon) |
$139 |
$278 |
— |
$115 | |
| Copper blood test |
$106 |
$211 |
$6 |
$12 | |
| Corneal transplant |
$1,281 |
$2,562 |
— |
$1,066 | |
| Coronary CT angiography |
$135 |
$270 |
— |
$326 | |
| Cortisol test |
$22 |
$43 |
$8 |
$16 | |
| CPAP titration study |
$207 |
$414 |
$3,184 |
$69 | |
| Creatine kinase (CK) test |
$23 |
$45 |
$3 |
$7 | |
| CT angiography of the chest |
$1,173 |
$2,346 |
— |
$281 | |
| CT angiography of the head |
$1,110 |
$2,219 |
— |
$274 | |
| CT scan of the abdomen |
$1,093 |
$2,186 |
— |
$230 | |
| CT scan of the abdomen and pelvis |
$1,717 |
$3,434 |
— |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$2,375 |
$4,749 |
— |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$1,905 |
$3,810 |
— |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$1,442 |
$2,884 |
— |
$183 | |
| CT scan of the abdomen with and without contrast |
$1,300 |
$2,599 |
— |
$259 | |
| CT scan of the abdomen with contrast |
$1,093 |
$2,186 |
— |
$230 | |
| CT scan of the abdomen without contrast |
$932 |
$1,863 |
— |
$136 | |
| CT scan of the arm |
$775 |
$1,550 |
— |
$199 | |
| CT scan of the arm with contrast |
$731 |
$1,462 |
— |
$199 | |
| CT scan of the arm without contrast |
$1,017 |
$2,033 |
— |
$161 | |
| CT scan of the chest |
$901 |
$1,801 |
— |
$167 | |
| CT scan of the chest with contrast |
$1,044 |
$2,088 |
— |
$167 | |
| CT scan of the chest without contrast |
$901 |
$1,801 |
— |
$133 | |
| CT scan of the head |
$801 |
$1,601 |
— |
$148 | |
| CT scan of the head with and without contrast |
$1,154 |
$2,307 |
— |
$173 | |
| CT scan of the head without contrast |
$801 |
$1,601 |
— |
$107 | |
| CT scan of the leg |
$840 |
$1,680 |
— |
$166 | |
| CT scan of the leg with contrast |
$840 |
$1,680 |
— |
$166 | |
| CT scan of the leg without contrast |
$882 |
$1,763 |
— |
$130 | |
| CT scan of the lower back (lumbar spine) |
$822 |
$1,644 |
— |
$169 | |
| CT scan of the lower back (lumbar spine) with contrast |
$822 |
$1,644 |
— |
$169 | |
| CT scan of the lower back (lumbar spine) without contrast |
$1,032 |
$2,064 |
— |
$130 | |
| CT scan of the neck |
$837 |
$1,673 |
— |
$183 | |
| CT scan of the neck (cervical spine) |
$1,043 |
$2,085 |
— |
$168 | |
| CT scan of the neck (cervical spine) with contrast |
$584 |
$1,167 |
— |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$1,043 |
$2,085 |
— |
$131 | |
| CT scan of the neck with contrast |
$837 |
$1,673 |
— |
$183 | |
| CT scan of the neck without contrast |
$870 |
$1,739 |
— |
$150 | |
| CT scan of the pelvis |
$949 |
$1,898 |
— |
$226 | |
| CT scan of the pelvis with contrast |
$949 |
$1,898 |
— |
$226 | |
| CT scan of the pelvis without contrast |
$895 |
$1,790 |
— |
$133 | |
| CT scan of the sinuses |
$910 |
$1,819 |
— |
$152 | |
| CT scan of the sinuses with and without contrast |
$1,694 |
$3,388 |
— |
$184 | |
| CT scan of the sinuses with contrast |
$1,023 |
$2,045 |
— |
$152 | |
| CT scan of the sinuses without contrast |
$858 |
$1,716 |
— |
$128 | |
| D-dimer test |
$80 |
$160 |
$5 |
$10 | |
| Developmental screening (child) |
$13 |
$25 |
— |
— | |
| DHEA-sulfate test |
$242 |
$483 |
$11 |
$22 | |
| Diagnostic mammogram |
$52 |
$103 |
— |
$140 | |
| Dialysis fistula creation |
$740 |
$1,479 |
— |
$601 | |
| Droopy eyelid repair (ptosis) |
$611 |
$1,221 |
— |
$745 | |
| Drug screen (urine) |
$60 |
$119 |
$29 |
$17 | |
| Ear pressure test (tympanometry) |
$11 |
$21 |
— |
$16 | |
| Echocardiogram |
$353 |
$706 |
— |
$138 | |
| Echocardiogram with and without contrast |
$192 |
$383 |
— |
$101 | |
| EKG / ECG (tracing only) |
$108 |
$215 |
— |
$7 | |
| Electrocardiogram (EKG) |
$108 |
$215 |
— |
$8 | |
| Electrolyte panel |
$33 |
$65 |
$3 |
$7 | |
| Emergency department visit |
$303 |
$605 |
— |
$69 | |
| Emergency department visit (level 1) |
$196 |
$392 |
— |
$11 | |
| Emergency department visit (level 2) |
$264 |
$527 |
— |
$40 | |
| Emergency department visit (level 3) |
$488 |
$975 |
— |
$69 | |
| Emergency department visit (level 4) |
$303 |
$605 |
— |
$118 | |
| Emergency department visit (level 5) |
$972 |
$1,943 |
— |
$171 | |
| Endometrial biopsy |
$132 |
$264 |
— |
$98 | |
| Estradiol (estrogen) test |
$112 |
$224 |
$14 |
$28 | |
| Eye refraction (glasses prescription) |
$19 |
$38 |
— |
— | |
| Eyelid surgery (blepharoplasty) |
$500 |
$1,001 |
— |
$552 | |
| Fallopian tube X-ray (HSG) |
$64 |
$127 |
— |
$164 | |
| Family therapy session |
$128 |
$256 |
— |
$110 | |
| Fecal occult blood (stool) test |
$37 |
$75 |
$5 |
$10 | |
| Fecal occult blood (stool) test (guaiac, gFOBT) |
$26 |
$52 |
$2 |
$4 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
$49 |
$97 |
$8 |
$16 | |
| Feeding tube (PEG) placement |
$219 |
$437 |
— |
$178 | |
| Femoral hernia repair |
$709 |
$1,418 |
— |
$584 | |
| Ferritin (iron) test |
$162 |
$323 |
$7 |
$14 | |
| Fibrinogen test |
$56 |
$111 |
$4 |
$10 | |
| Fibroid removal (myomectomy) |
$1,119 |
$2,239 |
— |
$914 | |
| Flu test |
$30 |
$60 |
$7 |
$17 | |
| Folate (folic acid) test |
$162 |
$323 |
$7 |
$15 | |
| Foreign body removal (skin) |
$244 |
$489 |
— |
$157 | |
| Free T4 thyroid test |
$52 |
$103 |
$4 |
$9 | |
| FSH hormone test |
$105 |
$210 |
$9 |
$19 | |
| Gallbladder removal (laparoscopic) |
$801 |
$1,602 |
— |
$658 | |
| Ganglion cyst removal |
$382 |
$763 |
— |
$321 | |
| GGT liver test |
$41 |
$82 |
$4 |
$7 | |
| Glucose tolerance test |
$118 |
$235 |
$6 |
$8 | |
| H. pylori test |
$60 |
$120 |
$33 |
$67 | |
| Hammertoe repair |
$446 |
$892 |
— |
$548 | |
| HDL cholesterol test |
$51 |
$102 |
$4 |
$8 | |
| Hearing test (audiometry) |
$32 |
$63 |
— |
$36 | |
| Hemoglobin A1c (diabetes test) |
$96 |
$191 |
$5 |
$10 | |
| Hemorrhoid removal |
$325 |
$650 |
— |
$338 | |
| Hepatitis A vaccine |
$100 |
$200 |
$116 |
— | |
| Hepatitis B test |
$14 |
$28 |
$5 |
$10 | |
| Hepatitis B vaccine |
$67 |
$133 |
$116 |
— | |
| Hepatitis C test |
$66 |
$131 |
$7 |
$14 | |
| Hip fracture repair |
$1,357 |
$2,715 |
— |
$1,120 | |
| Hip replacement |
$1,411 |
$2,822 |
— |
$1,162 | |
| HIV test |
$83 |
$166 |
$12 |
$19 | |
| HIV test (antigen/antibody combo) |
$83 |
$166 |
$12 |
$24 | |
| Holter heart monitor |
$469 |
$938 |
— |
$26 | |
| Home sleep apnea test |
$48 |
$95 |
— |
$123 | |
| HPV vaccine |
$412 |
$823 |
$569 |
— | |
| Hydrocele repair |
$382 |
$763 |
— |
$315 | |
| Hysterectomy |
$1,075 |
$2,151 |
— |
$933 | |
| Ileostomy |
$1,182 |
$2,364 |
— |
$968 | |
| Inguinal hernia repair |
$653 |
$1,306 |
— |
$538 | |
| Iron blood test |
$65 |
$130 |
$3 |
$6 | |
| IUD insertion |
$97 |
$195 |
— |
— | |
| IUD removal |
$260 |
$521 |
— |
$112 | |
| IV infusion therapy |
$303 |
$605 |
— |
$44 | |
| IV infusion therapy (each additional) |
$88 |
$176 |
— |
$21 | |
| IV infusion therapy (initial) |
$314 |
$627 |
— |
$67 | |
| Joint aspiration (small/intermediate) |
$322 |
$644 |
— |
$57 | |
| Joint aspiration or injection (mid-size joint) |
$206 |
$411 |
— |
$57 | |
| Joint aspiration or injection (small joint) |
$322 |
$644 |
— |
$56 | |
| Kidney stone shock-wave (lithotripsy) |
$634 |
$1,268 |
— |
$760 | |
| Kidney ultrasound |
$347 |
$694 |
— |
$84 | |
| Kidney ultrasound (limited) |
$347 |
$694 |
— |
$61 | |
| Knee arthroscopy |
$630 |
$1,260 |
— |
$524 | |
| Knee joint injection |
$110 |
$220 |
— |
$69 | |
| Lactate test |
$105 |
$210 |
$5 |
$12 | |
| Laminectomy (spine) |
$1,515 |
$3,030 |
— |
$1,157 | |
| Laryngoscopy |
$121 |
$242 |
— |
$189 | |
| LDH test |
$40 |
$80 |
$3 |
$6 | |
| LDL cholesterol test |
$61 |
$121 |
$5 |
$11 | |
| Leg vein ultrasound (Doppler) |
$296 |
$592 |
— |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$174 |
$347 |
— |
$116 | |
| LH hormone test |
$41 |
$82 |
$9 |
$19 | |
| Lipase test |
$47 |
$94 |
$3 |
$7 | |
| Lipid (cholesterol) panel |
$63 |
$125 |
$9 |
$13 | |
| Liver function panel |
$38 |
$76 |
$4 |
$8 | |
| Lumpectomy (breast) |
$911 |
$1,822 |
— |
$750 | |
| Lung function test (PFT) |
$207 |
$414 |
— |
$37 | |
| Magnesium blood test |
$22 |
$45 |
$3 |
$7 | |
| Mastectomy |
$1,240 |
$2,481 |
— |
$1,021 | |
| Meniscus repair (knee) |
$861 |
$1,723 |
— |
$714 | |
| MMR vaccine |
$126 |
$251 |
$182 |
— | |
| Mohs skin cancer surgery |
$352 |
$704 |
— |
$535 | |
| MRA of the brain |
$812 |
$1,623 |
— |
$226 | |
| MRA of the neck without contrast |
$885 |
$1,770 |
— |
$343 | |
| MRI of the abdomen |
$1,858 |
$3,716 |
— |
$300 | |
| MRI of the abdomen without contrast |
$1,753 |
$3,505 |
— |
$194 | |
| MRI of the ankle |
$1,526 |
$3,051 |
— |
$261 | |
| MRI of the ankle without contrast |
$1,526 |
$3,051 |
— |
$222 | |
| MRI of the brain |
$1,626 |
$3,252 |
— |
$269 | |
| MRI of the brain with contrast |
$1,477 |
$2,953 |
— |
$269 | |
| MRI of the brain without contrast |
$1,626 |
$3,252 |
— |
$195 | |
| MRI of the knee |
$1,753 |
$3,505 |
— |
$315 | |
| MRI of the knee without contrast |
$1,753 |
$3,505 |
— |
$204 | |
| MRI of the lower back (lumbar spine) |
$1,699 |
$3,397 |
— |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$1,911 |
$3,821 |
— |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$1,649 |
$3,298 |
— |
$192 | |
| MRI of the mid-back (thoracic spine) |
$1,649 |
$3,298 |
— |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$1,914 |
$3,828 |
— |
$319 | |
| MRI of the mid-back (thoracic spine) without contrast |
$1,649 |
$3,298 |
— |
$190 | |
| MRI of the neck (cervical spine) |
$1,649 |
$3,298 |
— |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$2,092 |
$4,184 |
— |
$318 | |
| MRI of the neck (cervical spine) without contrast |
$1,649 |
$3,298 |
— |
$191 | |
| MRI of the pelvis |
$219 |
$438 |
— |
$268 | |
| MRI of the pelvis without contrast |
$219 |
$438 |
— |
$227 | |
| MRI of the shoulder |
$1,451 |
$2,902 |
— |
$313 | |
| MRI of the shoulder without contrast |
$1,451 |
$2,902 |
— |
$205 | |
| MRI of the wrist |
$1,426 |
$2,852 |
— |
$330 | |
| MRI of the wrist without contrast |
$1,426 |
$2,852 |
— |
$303 | |
| Nebulizer breathing treatment |
$123 |
$245 |
$3,184 |
$9 | |
| Nerve conduction study |
$82 |
$163 |
— |
$118 | |
| Newborn hospital care |
$72 |
$143 |
— |
$58 | |
| Nuchal translucency ultrasound |
$69 |
$138 |
— |
$116 | |
| Occupational therapy evaluation |
$145 |
$289 |
— |
$101 | |
| Occupational therapy evaluation (high complexity) |
$135 |
$270 |
— |
$101 | |
| Occupational therapy evaluation (low complexity) |
$167 |
$334 |
— |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$145 |
$289 |
— |
$101 | |
| Office visit (established patient) |
$85 |
$169 |
— |
$115 | |
| Office visit (new patient) |
$118 |
$235 |
— |
$177 | |
| Office visit, established patient (level 3) |
$80 |
$159 |
— |
$95 | |
| Office visit, established patient (level 4) |
$104 |
$208 |
— |
$136 | |
| Office visit, new patient (level 3) |
$94 |
$187 |
— |
$118 | |
| Office visit, new patient (level 4) |
$162 |
$323 |
— |
$177 | |
| Office visit, new patient (level 5) |
$157 |
$315 |
— |
$237 | |
| Orthopedic hardware removal |
$501 |
$1,002 |
— |
$632 | |
| Ovary removal (oophorectomy) |
$624 |
$1,248 |
— |
$822 | |
| Pap smear (cervical screening) |
$108 |
$215 |
$13 |
$20 | |
| Parathyroid hormone (PTH) test |
$133 |
$265 |
$20 |
$41 | |
| Parathyroid removal |
$1,086 |
$2,172 |
— |
$891 | |
| Pelvic ultrasound |
$314 |
$628 |
— |
$78 | |
| Pelvic ultrasound (complete) |
$397 |
$794 |
— |
$105 | |
| Pelvic ultrasound (limited) |
$280 |
$560 |
— |
$51 | |
| Phosphorus blood test |
$41 |
$82 |
$2 |
$5 | |
| Physical therapy evaluation |
$172 |
$343 |
— |
$98 | |
| Physical therapy evaluation (high complexity) |
$151 |
$301 |
— |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$178 |
$356 |
— |
$98 | |
| Pilonidal cyst removal |
$375 |
$751 |
— |
$541 | |
| Platelet count |
$7 |
$13 |
$2 |
$4 | |
| Pneumonia vaccine |
$157 |
$314 |
$220 |
— | |
| Pregnancy blood test (hCG) |
$55 |
$110 |
$4 |
$8 | |
| Pregnancy ultrasound |
$333 |
$666 |
— |
$126 | |
| Pregnancy ultrasound (first trimester) |
$333 |
$666 |
— |
$117 | |
| Pregnancy ultrasound (second or third trimester) |
$57 |
$114 |
— |
$136 | |
| Procalcitonin test |
$444 |
$888 |
$13 |
$27 | |
| Prolactin test |
$109 |
$218 |
$10 |
$19 | |
| Prostate surgery (TURP) |
$641 |
$1,282 |
— |
$526 | |
| Prostate test (PSA) |
$88 |
$176 |
$9 |
$18 | |
| Psychiatric evaluation |
$184 |
$368 |
— |
$188 | |
| Psychotherapy session |
$141 |
$282 |
— |
$140 | |
| Pulmonary rehabilitation |
$88 |
$177 |
— |
$87 | |
| Retina scan (OCT) |
$22 |
$43 |
— |
$33 | |
| Retinal (fundus) photography |
$25 |
$49 |
— |
$37 | |
| Rotator cuff repair |
$956 |
$1,911 |
— |
$792 | |
| Routine eye exam |
$51 |
$101 |
— |
$88 | |
| RSV vaccine |
$406 |
$812 |
$584 |
— | |
| Sacroiliac joint injection |
$385 |
$769 |
— |
$176 | |
| Scoliosis spine X-ray (3 views) |
$150 |
$300 |
— |
$72 | |
| Screening colonoscopy |
$215 |
$430 |
— |
$378 | |
| Screening mammogram |
$184 |
$368 |
— |
$126 | |
| Scrotal ultrasound |
$455 |
$910 |
— |
$99 | |
| Sedimentation rate (ESR) test |
$45 |
$90 |
$1 |
$3 | |
| Sex hormone binding globulin test |
$104 |
$207 |
$11 |
$22 | |
| Shingles vaccine |
$262 |
$523 |
— |
— | |
| Shoulder arthroscopy |
$1,163 |
$2,327 |
— |
$962 | |
| Shoulder replacement |
$1,580 |
$3,159 |
— |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
$178 |
$356 |
— |
$114 | |
| Simple wound stitches |
$178 |
$356 |
— |
$127 | |
| Skin biopsy |
$57 |
$114 |
— |
$121 | |
| Skin biopsy (punch) |
$206 |
$413 |
— |
$121 | |
| Skin cancer lesion removal |
$181 |
$362 |
— |
$240 | |
| Skin graft |
$770 |
$1,540 |
— |
$898 | |
| Skin lesion freezing (cryotherapy) |
$57 |
$114 |
— |
$36 | |
| Skin tag removal |
$135 |
$270 |
— |
$92 | |
| Small bowel resection |
$1,391 |
$2,782 |
— |
$1,136 | |
| Soft tissue ultrasound |
$373 |
$746 |
— |
$64 | |
| Speech therapy |
$182 |
$364 |
— |
$76 | |
| Spirometry (lung function test) |
$161 |
$322 |
— |
$30 | |
| Spirometry with bronchodilator |
$342 |
$684 |
— |
$43 | |
| Spleen removal (splenectomy) |
$1,266 |
$2,531 |
— |
$1,036 | |
| Stomach removal (gastrectomy) |
$1,658 |
$3,316 |
— |
$1,595 | |
| Strep throat test |
$30 |
$61 |
$7 |
$17 | |
| Swallow study |
$190 |
$380 |
— |
$85 | |
| T3 thyroid test |
$92 |
$184 |
$7 |
$14 | |
| Tdap (tetanus) vaccine |
$53 |
$106 |
$63 |
— | |
| Testicle removal (orchiectomy) |
$371 |
$741 |
— |
$306 | |
| Testosterone test |
$92 |
$184 |
$13 |
$26 | |
| Thyroid removal (thyroidectomy) |
$1,012 |
$2,023 |
— |
$1,004 | |
| Thyroid test (TSH) |
$80 |
$159 |
$8 |
$17 | |
| Thyroid ultrasound |
$437 |
$873 |
— |
$109 | |
| Total IgE allergy test |
$75 |
$149 |
$8 |
$16 | |
| Total protein test |
$43 |
$85 |
$2 |
$4 | |
| Tracheostomy |
$336 |
$671 |
— |
$273 | |
| Transvaginal ultrasound |
$422 |
$844 |
— |
$118 | |
| Trigger finger release |
$342 |
$683 |
— |
$630 | |
| Trigger point injection |
$265 |
$529 |
— |
$56 | |
| Trigger point injection (1-2 muscles) |
$265 |
$529 |
— |
$52 | |
| Triglycerides test |
$46 |
$91 |
$3 |
$6 | |
| Troponin (heart) test |
$94 |
$187 |
$5 |
$12 | |
| Tubal ligation |
$405 |
$810 |
— |
$333 | |
| Ulnar nerve surgery (elbow) |
$688 |
$1,376 |
— |
$575 | |
| Ureteral stent placement |
$2,221 |
$4,441 |
— |
$373 | |
| Uric acid (gout) test |
$41 |
$82 |
$2 |
$5 | |
| Urinalysis |
$34 |
$67 |
$1 |
$3 | |
| Urine microalbumin test |
$18 |
$35 |
$3 |
$5 | |
| Urine pregnancy test |
$10 |
$20 |
$3 |
$9 | |
| Vaccine administration |
$36 |
$72 |
— |
$19 | |
| Vaccine administration (each additional) |
$34 |
$69 |
— |
$16 | |
| Varicocele repair |
$396 |
$792 |
— |
$327 | |
| Vasectomy |
$263 |
$525 |
— |
$347 | |
| Visual field test |
$32 |
$64 |
— |
$64 | |
| Vitamin B12 test |
$162 |
$323 |
$7 |
$15 | |
| Vitamin D test |
$72 |
$143 |
$17 |
$30 | |
| Vitrectomy (eye) |
$913 |
$1,826 |
— |
$814 | |
| Wart removal |
$186 |
$371 |
— |
$121 | |
| Well-child visit |
$71 |
$141 |
— |
— | |
| Wound debridement |
$169 |
$338 |
— |
$186 | |
| Wrist fracture repair |
$883 |
$1,766 |
— |
$735 | |
| X-ray of the abdomen |
$162 |
$323 |
— |
$36 | |
| X-ray of the ankle |
$187 |
$373 |
— |
$37 | |
| X-ray of the collarbone |
$158 |
$316 |
— |
$33 | |
| X-ray of the elbow |
$184 |
$367 |
— |
$33 | |
| X-ray of the foot |
$182 |
$363 |
— |
$34 | |
| X-ray of the forearm |
$154 |
$307 |
— |
$29 | |
| X-ray of the hand |
$183 |
$365 |
— |
$38 | |
| X-ray of the hip |
$124 |
$247 |
— |
$49 | |
| X-ray of the hip (1 view) |
$116 |
$231 |
— |
$34 | |
| X-ray of the hip (3 views) |
$187 |
$373 |
— |
$49 | |
| X-ray of the knee |
$207 |
$415 |
— |
$42 | |
| X-ray of the knee (2 views) |
$163 |
$325 |
— |
$34 | |
| X-ray of the knee (3 views) |
$242 |
$484 |
— |
$42 | |
| X-ray of the knee (4+ views) |
$245 |
$490 |
— |
$49 | |
| X-ray of the lower back (lumbar spine) |
$216 |
$432 |
— |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$210 |
$419 |
— |
$40 | |
| X-ray of the lower back (lumbar spine) (4+ views) |
$285 |
$569 |
— |
$53 | |
| X-ray of the lower leg |
$171 |
$342 |
— |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$210 |
$419 |
— |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$199 |
$397 |
— |
$33 | |
| X-ray of the mid-back (thoracic spine) (3 views) |
$210 |
$419 |
— |
$39 | |
| X-ray of the neck (cervical spine) |
$201 |
$401 |
— |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$189 |
$378 |
— |
$40 | |
| X-ray of the pelvis |
$93 |
$187 |
— |
$36 | |
| X-ray of the pelvis (1 view) |
$172 |
$343 |
— |
$28 | |
| X-ray of the ribs |
$285 |
$569 |
— |
$42 | |
| X-ray of the ribs (2 views) |
$285 |
$569 |
— |
$36 | |
| X-ray of the ribs (3 views) |
$332 |
$664 |
— |
$42 | |
| X-ray of the shoulder |
$180 |
$359 |
— |
$36 | |
| X-ray of the upper arm |
$178 |
$355 |
— |
$32 | |
| X-ray of the wrist |
$197 |
$394 |
— |
$43 | |
| YAG laser capsulotomy (eye) |
$327 |
$654 |
— |
$335 | |
| Zinc blood test |
$43 |
$85 |
$6 |
$11 | |