| 3D mammogram (tomosynthesis) |
$113 |
$113 |
$28 |
$51 | |
| Abdominal fluid drain (paracentesis) |
— |
— |
$3,339 |
$284 | |
| Abdominal ultrasound |
$4,931 |
$4,931 |
$1,276 |
$100 | |
| Abdominal ultrasound (limited) |
$2,552 |
$2,552 |
$590 |
$86 | |
| Abscess drainage (complex or multiple) |
— |
— |
$2,855 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$2,750 |
$129 | |
| Abscess incision and drainage |
— |
— |
$2,855 |
$174 | |
| Achilles tendon repair |
— |
— |
$8,253 |
$624 | |
| ACL knee reconstruction |
— |
— |
$11,754 |
$889 | |
| Acupuncture |
— |
— |
$33 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$30 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$6,802 |
$204 | |
| Albumin blood test |
$117 |
$117 |
$6 |
$5 | |
| Aldosterone test |
$220 |
$220 |
$44 |
$41 | |
| Alkaline phosphatase test |
$315 |
$315 |
$6 |
$5 | |
| Allergy patch testing |
— |
— |
$53 |
$5 | |
| Allergy shots |
— |
— |
$11 |
$11 | |
| Allergy testing |
— |
— |
$52 |
$4 | |
| Alpha-fetoprotein (AFP) test |
$92 |
$92 |
$18 |
$17 | |
| Amniocentesis |
— |
— |
$3,339 |
$120 | |
| Anal fistula repair |
— |
— |
$6,802 |
$541 | |
| Ankle fracture repair |
— |
— |
$8,253 |
$608 | |
| Ankle replacement |
— |
— |
$6,802 |
$885 | |
| Annual physical (established patient) |
— |
— |
$74 |
— | |
| Annual physical (new patient) |
— |
— |
$85 |
— | |
| Anoscopy |
— |
— |
$3,057 |
$129 | |
| Antinuclear antibody (ANA) test |
$355 |
$355 |
$15 |
$12 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$6,802 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$6,802 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$7,000 |
$592 | |
| Arterial blood gas (ABG) |
$813 |
$813 |
$138 |
$26 | |
| Barium swallow study |
$4,334 |
$4,334 |
$755 |
$107 | |
| Bartholin cyst removal |
— |
— |
$3,057 |
$182 | |
| Benign skin lesion removal |
— |
— |
$3,473 |
$171 | |
| Bladder function test (urodynamics) |
— |
— |
$3,473 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$4,963 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$6,802 |
$236 | |
| Blood clotting test (PT/INR) |
$353 |
$353 |
$5 |
$4 | |
| Blood crossmatch |
$347 |
$347 |
$142 |
— | |
| Blood transfusion |
$2,410 |
$2,410 |
$2,050 |
$47 | |
| Blood type and screen |
$193 |
$193 |
$12 |
$10 | |
| Blood type test |
$441 |
$441 |
$4 |
$3 | |
| Blood type test (ABO group) |
$531 |
$531 |
$4 |
$3 | |
| Blood type test (Rh/D antigen) |
$351 |
$351 |
$4 |
$3 | |
| BNP (heart failure) test |
$925 |
$925 |
$47 |
$39 | |
| Bone density scan (DEXA) |
$1,395 |
$1,395 |
$307 |
$39 | |
| Bone marrow biopsy |
— |
— |
$6,802 |
$172 | |
| Botox for migraine |
— |
— |
$3,057 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$6,802 |
$1,023 | |
| Breast biopsy |
— |
— |
$5,884 |
$478 | |
| Breast MRI |
$3,992 |
$3,992 |
$838 |
$216 | |
| Breast MRI without contrast |
$3,992 |
$3,992 |
$878 |
$216 | |
| Breast reconstruction |
— |
— |
$11,754 |
$1,227 | |
| Breast reduction |
— |
— |
$11,754 |
$980 | |
| Breathing tube insertion (intubation) |
— |
— |
$3,057 |
$133 | |
| Bronchoscopy |
— |
— |
$6,294 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$6,802 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$2,750 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$2,750 |
$93 | |
| Burn treatment |
— |
— |
$2,750 |
$129 | |
| C-reactive protein (CRP) |
$263 |
$263 |
$6 |
$5 | |
| CA 19-9 tumor marker test |
$114 |
$114 |
$22 |
$21 | |
| CA-125 ovarian marker test |
$114 |
$114 |
$22 |
$21 | |
| Calcium blood test |
$285 |
$285 |
$6 |
$5 | |
| Capsule endoscopy |
— |
— |
$3,120 |
$802 | |
| Cardiac ablation |
— |
— |
$17,832 |
$759 | |
| Cardiac catheterization |
— |
— |
$9,333 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$219 |
$170 | |
| Cardiac MRI |
— |
— |
$2,097 |
$322 | |
| Cardiac MRI without contrast |
— |
— |
$2,097 |
$280 | |
| Cardiac rehabilitation |
— |
— |
$37 |
$26 | |
| Cardiac stress test |
$626 |
$626 |
$138 |
$39 | |
| Cardioversion |
$4,457 |
$4,457 |
$1,982 |
$155 | |
| Carotid artery surgery |
— |
— |
$6,802 |
$1,026 | |
| Carotid artery ultrasound |
$2,666 |
$2,666 |
$587 |
$156 | |
| Carpal tunnel release |
— |
— |
$6,802 |
$483 | |
| Cataract surgery |
— |
— |
$6,802 |
$547 | |
| CEA tumor marker test |
$738 |
$738 |
$23 |
$19 | |
| Celiac disease test |
$165 |
$165 |
$14 |
$12 | |
| Central line placement |
— |
— |
$11,172 |
$238 | |
| Cervical cerclage |
— |
— |
$6,802 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$6,802 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$10,305 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$3,057 |
$131 | |
| Chemotherapy infusion |
— |
— |
$127 |
$81 | |
| Chemotherapy infusion (each additional) |
— |
— |
$67 |
$28 | |
| Chemotherapy infusion (first hour) |
— |
— |
$629 |
$133 | |
| Chest fluid drain (thoracentesis) |
— |
— |
$3,339 |
$311 | |
| Chest tube insertion |
— |
— |
$3,473 |
$143 | |
| Chest X-ray (1 view) |
$1,157 |
$1,157 |
$255 |
$25 | |
| Chickenpox (varicella) vaccine |
— |
— |
$380 |
— | |
| Chiropractic adjustment |
— |
— |
$38 |
$38 | |
| Circumcision |
— |
— |
$6,802 |
$167 | |
| CK-MB heart enzyme test |
— |
— |
$12 |
$12 | |
| Clotting time test (PTT) |
$367 |
$367 |
$7 |
$6 | |
| Colon resection (colectomy) |
— |
— |
$6,802 |
$1,238 | |
| Colonoscopy |
— |
— |
$4,708 |
$480 | |
| Colostomy |
— |
— |
$6,802 |
$1,122 | |
| Colposcopy |
— |
— |
$3,057 |
$161 | |
| Complete blood count (CBC) (complete) |
— |
— |
$8 |
$8 | |
| Complex wound repair |
— |
— |
$3,339 |
$390 | |
| Comprehensive eye exam |
— |
— |
$97 |
$138 | |
| Contact lens fitting |
— |
— |
$83 |
— | |
| Continuous glucose monitor setup |
— |
— |
$41 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$3,057 |
$115 | |
| Copper blood test |
$67 |
$67 |
$13 |
$12 | |
| Corneal transplant |
— |
— |
$8,253 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$3,890 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$36,487 |
$36,593 | |
| Coronary CT angiography |
— |
— |
$2,097 |
$326 | |
| Cortisol test |
$87 |
$87 |
$17 |
$16 | |
| COVID-19 PCR test |
$71 |
$71 |
$51 |
$51 | |
| CPAP titration study |
$1,703 |
$1,703 |
$375 |
$69 | |
| Craniotomy (brain surgery) |
— |
— |
$6,802 |
$2,161 | |
| Creatine kinase (CK) test |
$417 |
$417 |
$8 |
$7 | |
| CT angiography of the chest |
$12,949 |
$12,949 |
$2,097 |
$281 | |
| CT angiography of the head |
$12,949 |
$12,949 |
$2,097 |
$274 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$2,097 |
$835 | |
| CT scan of the arm |
$12,696 |
$12,696 |
$2,119 |
$199 | |
| CT scan of the arm with contrast |
$12,160 |
$12,160 |
$2,108 |
$199 | |
| CT scan of the head |
$11,169 |
$11,169 |
$2,097 |
$148 | |
| CT scan of the head with and without contrast |
$11,169 |
$11,169 |
$2,097 |
$173 | |
| CT scan of the head with contrast |
$9,971 |
$9,971 |
$2,097 |
$148 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
$15,834 |
$15,834 |
$2,097 |
$197 | |
| CT scan of the lower back (lumbar spine) with contrast |
$15,412 |
$15,412 |
$2,097 |
$169 | |
| CT scan of the neck (cervical spine) |
$14,260 |
$14,260 |
$2,097 |
$168 | |
| CT scan of the neck (cervical spine) with and without contrast |
$14,260 |
$14,260 |
$2,097 |
$196 | |
| CT scan of the neck (cervical spine) with contrast |
$15,731 |
$15,731 |
$2,097 |
$168 | |
| CT scan of the sinuses with and without contrast |
— |
— |
$2,097 |
$184 | |
| D-dimer test |
$167 |
$167 |
$12 |
$10 | |
| Defibrillator (ICD) implant |
— |
— |
$23,547 |
$798 | |
| Developmental screening (child) |
— |
— |
$85 |
— | |
| DHEA-sulfate test |
$123 |
$123 |
$24 |
$22 | |
| Diagnostic mammogram |
$659 |
$659 |
$140 |
$140 | |
| Dialysis fistula creation |
— |
— |
$17,341 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$6,802 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$6,802 |
$745 | |
| Ear pressure test (tympanometry) |
— |
— |
$200 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$4,084 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$7,528 |
$799 | |
| Echocardiogram |
$4,438 |
$4,438 |
$964 |
$138 | |
| Echocardiogram with and without contrast |
$3,030 |
$3,030 |
$667 |
$101 | |
| Echocardiogram without contrast |
— |
— |
$1,322 |
$138 | |
| EEG (awake and asleep) |
$1,041 |
$1,041 |
$239 |
$482 | |
| EKG / ECG (tracing only) |
$1,272 |
$1,272 |
$280 |
$7 | |
| Elbow replacement |
— |
— |
$8,253 |
$1,301 | |
| Electrocardiogram (EKG) |
$1,272 |
$1,272 |
$280 |
$8 | |
| Electroencephalogram (EEG) |
$1,041 |
$1,041 |
$239 |
$448 | |
| Electrolyte panel |
$353 |
$353 |
$8 |
$7 | |
| Electromyography (EMG) |
— |
— |
$138 |
$141 | |
| Emergency department visit |
$3,769 |
$3,769 |
$1,925 |
$69 | |
| Emergency department visit (level 1) |
$1,565 |
$1,565 |
$978 |
$11 | |
| Emergency department visit (level 2) |
$2,312 |
$2,312 |
$1,560 |
$40 | |
| Emergency department visit (level 3) |
$3,769 |
$3,769 |
$1,989 |
$69 | |
| Emergency department visit (level 4) |
$4,856 |
$4,856 |
$2,428 |
$118 | |
| Emergency department visit (level 5) |
$7,046 |
$7,046 |
$3,171 |
$171 | |
| Endometrial biopsy |
— |
— |
$3,057 |
$98 | |
| Epidural steroid injection |
— |
— |
$3,473 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$6,802 |
$311 | |
| Esophageal dilation |
— |
— |
$5,303 |
$522 | |
| Esophageal variceal banding |
— |
— |
$6,294 |
$126 | |
| Estradiol (estrogen) test |
$153 |
$153 |
$30 |
$28 | |
| Eye refraction (glasses prescription) |
— |
— |
$43 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$6,294 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$3,057 |
$99 | |
| Family therapy session |
$555 |
$555 |
$122 |
$110 | |
| Fecal occult blood (stool) test |
$130 |
$130 |
$16 |
$10 | |
| Fecal occult blood (stool) test (guaiac, gFOBT) |
$130 |
$130 |
$5 |
$4 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
— |
— |
$16 |
$16 | |
| Feeding tube (PEG) placement |
— |
— |
$6,294 |
$178 | |
| Femoral hernia repair |
— |
— |
$6,802 |
$584 | |
| Ferritin (iron) test |
$74 |
$74 |
$15 |
$14 | |
| Fibrinogen test |
$512 |
$512 |
$12 |
$10 | |
| Fibroid removal (myomectomy) |
— |
— |
$7,583 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$3,473 |
$323 | |
| Flu test |
— |
— |
$17 |
$17 | |
| Flu vaccine |
$140 |
$140 |
$53 |
— | |
| Folate (folic acid) test |
$188 |
$188 |
$16 |
$15 | |
| Foreign body removal (skin) |
— |
— |
$2,855 |
$157 | |
| Free T4 thyroid test |
$127 |
$127 |
$11 |
$9 | |
| FSH hormone test |
$100 |
$100 |
$20 |
$19 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$11,255 |
$658 | |
| Gallbladder scan (HIDA) |
$7,859 |
$7,859 |
$1,729 |
$334 | |
| Ganglion cyst removal |
— |
— |
$5,933 |
$321 | |
| Glaucoma surgery |
— |
— |
$6,802 |
$984 | |
| Group therapy session |
$344 |
$344 |
$74 |
$30 | |
| H. pylori test |
— |
— |
$69 |
$67 | |
| Hammertoe repair |
— |
— |
$6,802 |
$548 | |
| HDL cholesterol test |
$202 |
$202 |
$10 |
$8 | |
| Hearing test (audiometry) |
— |
— |
$213 |
$36 | |
| Hematocrit test |
$178 |
$178 |
$3 |
$2 | |
| Hemodialysis |
— |
— |
$219 |
$75 | |
| Hemoglobin A1c (diabetes test) |
$273 |
$273 |
$12 |
$10 | |
| Hemorrhoid removal |
— |
— |
$5,933 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$121 |
— | |
| Hepatitis B test |
$572 |
$572 |
$12 |
$10 | |
| Hepatitis B vaccine |
$216 |
$216 |
$108 |
— | |
| Hepatitis C test |
$285 |
$285 |
$17 |
$14 | |
| Hip arthroscopy |
— |
— |
$11,754 |
$931 | |
| Hip fracture repair |
— |
— |
$6,802 |
$1,120 | |
| Hip replacement |
— |
— |
$6,802 |
$1,162 | |
| HIV test |
$187 |
$187 |
$24 |
$19 | |
| HIV test (antibody) |
— |
— |
$14 |
$14 | |
| HIV test (antigen/antibody combo) |
$187 |
$187 |
$26 |
$24 | |
| Holter heart monitor |
— |
— |
$154 |
$26 | |
| Home sleep apnea test |
— |
— |
$4,799 |
$123 | |
| HPV vaccine |
— |
— |
$651 |
— | |
| Hydrocele repair |
— |
— |
$6,802 |
$315 | |
| Hysterectomy |
— |
— |
$13,140 |
$933 | |
| Hysteroscopy |
— |
— |
$11,456 |
$1,270 | |
| Ileostomy |
— |
— |
$6,802 |
$968 | |
| Incisional hernia repair |
— |
— |
$8,392 |
— | |
| Inguinal hernia repair |
— |
— |
$7,193 |
$538 | |
| Iron blood test |
$145 |
$145 |
$8 |
$6 | |
| IUD insertion |
— |
— |
$4,963 |
— | |
| IUD removal |
— |
— |
$4,963 |
$112 | |
| IV infusion therapy |
$796 |
$796 |
$175 |
$44 | |
| IV infusion therapy (each additional) |
$399 |
$399 |
$104 |
$21 | |
| IV infusion therapy (initial) |
$796 |
$796 |
$207 |
$67 | |
| IVC filter placement |
— |
— |
$7,583 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$3,057 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
— |
— |
$3,057 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$3,057 |
$56 | |
| Kidney biopsy |
— |
— |
$5,473 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$9,160 |
$1,164 | |
| Kidney scan (nuclear) |
$3,226 |
$3,226 |
$903 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$13,726 |
$760 | |
| Kidney ultrasound |
$3,753 |
$3,753 |
$889 |
$84 | |
| Kidney ultrasound (limited) |
$3,753 |
$3,753 |
$889 |
$61 | |
| Knee arthroscopy |
— |
— |
$11,456 |
$524 | |
| Knee joint injection |
— |
— |
$3,057 |
$69 | |
| Knee replacement |
— |
— |
$19,524 |
$18,054 | |
| Lactate test |
$278 |
$278 |
$14 |
$12 | |
| Laminectomy (spine) |
— |
— |
$6,802 |
$1,157 | |
| Laryngoscopy |
— |
— |
$3,316 |
$189 | |
| LDH test |
$270 |
$270 |
$47 |
$6 | |
| LDL cholesterol test |
— |
— |
$11 |
$11 | |
| Leg artery angiogram |
$18,676 |
$18,676 |
$4,109 |
$149 | |
| Leg artery angioplasty |
— |
— |
$13,441 |
— | |
| Leg vein ultrasound (Doppler) (limited) |
$4,146 |
$4,146 |
$912 |
$116 | |
| LH hormone test |
$100 |
$100 |
$20 |
$19 | |
| Lipid (cholesterol) panel |
$605 |
$605 |
$16 |
$13 | |
| Liver biopsy |
— |
— |
$5,884 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$18,902 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$11,754 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$6,802 |
$750 | |
| Lung function test (PFT) |
$2,393 |
$2,393 |
$402 |
$37 | |
| Lung scan (V/Q) |
$6,681 |
$6,681 |
$1,503 |
$291 | |
| Magnesium blood test |
$285 |
$285 |
$8 |
$7 | |
| Mastectomy |
— |
— |
$6,802 |
$1,021 | |
| Mastoidectomy |
— |
— |
$6,802 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$11,456 |
$714 | |
| MMR vaccine |
— |
— |
$193 |
— | |
| Mohs skin cancer surgery |
— |
— |
$3,057 |
$535 | |
| MRA of the brain |
$8,437 |
$8,437 |
$2,097 |
$226 | |
| MRA of the brain with contrast |
$9,145 |
$9,145 |
$2,097 |
$226 | |
| MRA of the brain without contrast |
— |
— |
$2,097 |
$328 | |
| MRA of the neck |
$9,145 |
$9,145 |
$2,097 |
$245 | |
| MRA of the neck with contrast |
$9,145 |
$9,145 |
$2,097 |
$245 | |
| MRA of the neck without contrast |
$10,680 |
$10,680 |
$2,097 |
$343 | |
| MRI of the abdomen |
$6,447 |
$6,447 |
$2,097 |
$300 | |
| MRI of the abdomen with contrast |
$4,243 |
$4,243 |
$2,097 |
$300 | |
| MRI of the abdomen without contrast |
$6,447 |
$6,447 |
$2,097 |
$194 | |
| MRI of the ankle |
$7,729 |
$7,729 |
$2,097 |
$261 | |
| MRI of the ankle with contrast |
— |
— |
$2,097 |
$261 | |
| MRI of the ankle without contrast |
$7,729 |
$7,729 |
$2,097 |
$222 | |
| MRI of the brain |
$8,055 |
$8,055 |
$2,097 |
$269 | |
| MRI of the brain with contrast |
$8,055 |
$8,055 |
$2,097 |
$269 | |
| MRI of the brain without contrast |
$6,935 |
$6,935 |
$2,097 |
$195 | |
| MRI of the chest |
$8,564 |
$8,564 |
$2,097 |
$371 | |
| MRI of the chest with contrast |
— |
— |
$2,097 |
$371 | |
| MRI of the chest without contrast |
$10,680 |
$10,680 |
$2,097 |
$466 | |
| MRI of the knee |
$9,145 |
$9,145 |
$2,097 |
$315 | |
| MRI of the knee with contrast |
$9,145 |
$9,145 |
$2,097 |
$315 | |
| MRI of the knee without contrast |
$6,447 |
$6,447 |
$2,097 |
$204 | |
| MRI of the lower back (lumbar spine) |
$8,319 |
$8,319 |
$2,097 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$8,319 |
$8,319 |
$2,097 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$7,205 |
$7,205 |
$2,097 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$8,319 |
$8,319 |
$2,097 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$10,300 |
$10,300 |
$2,097 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$8,319 |
$8,319 |
$2,097 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$7,205 |
$7,205 |
$2,097 |
$190 | |
| MRI of the neck (cervical spine) |
$8,319 |
$8,319 |
$2,097 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$10,300 |
$10,300 |
$2,097 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$8,319 |
$8,319 |
$2,097 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$7,184 |
$7,184 |
$2,097 |
$191 | |
| MRI of the pelvis |
$7,729 |
$7,729 |
$2,097 |
$268 | |
| MRI of the pelvis with contrast |
$7,205 |
$7,205 |
$2,097 |
$268 | |
| MRI of the pelvis without contrast |
$7,729 |
$7,729 |
$2,097 |
$227 | |
| MRI of the shoulder |
$9,145 |
$9,145 |
$2,097 |
$313 | |
| MRI of the shoulder with contrast |
$9,145 |
$9,145 |
$2,097 |
$313 | |
| MRI of the shoulder without contrast |
$6,447 |
$6,447 |
$2,097 |
$205 | |
| MRI of the wrist |
$7,729 |
$7,729 |
$2,097 |
$330 | |
| MRI of the wrist with contrast |
$9,145 |
$9,145 |
$2,097 |
$330 | |
| MRI of the wrist without contrast |
$7,729 |
$7,729 |
$2,097 |
$303 | |
| Nebulizer breathing treatment |
$541 |
$541 |
$114 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$11,754 |
$1,410 | |
| Nerve conduction study |
— |
— |
$239 |
$118 | |
| Nuchal translucency ultrasound |
— |
— |
$636 |
$116 | |
| Nuclear cardiac stress test |
$23,425 |
$23,425 |
$5,154 |
$428 | |
| Occupational therapy evaluation |
$1,288 |
$1,288 |
$107 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$1,288 |
$1,288 |
$107 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$1,288 |
$1,288 |
$107 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$1,288 |
$1,288 |
$107 |
$101 | |
| Office visit (established patient) |
— |
— |
$115 |
$115 | |
| Office visit (new patient) |
— |
— |
$215 |
$177 | |
| Office visit, established patient (level 3) |
— |
— |
$100 |
$95 | |
| Office visit, established patient (level 4) |
— |
— |
$138 |
$136 | |
| Office visit, new patient (level 3) |
— |
— |
$176 |
$118 | |
| Office visit, new patient (level 4) |
— |
— |
$216 |
$177 | |
| Office visit, new patient (level 5) |
— |
— |
$215 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$6,802 |
$632 | |
| Ovarian cyst removal |
— |
— |
$7,583 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$7,583 |
$822 | |
| Pacemaker insertion |
— |
— |
$17,196 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$22 |
$20 | |
| Parathyroid hormone (PTH) test |
$224 |
$224 |
$44 |
$41 | |
| Parathyroid removal |
— |
— |
$8,253 |
$891 | |
| Pelvic ultrasound |
$3,396 |
$3,396 |
$716 |
$78 | |
| Pelvic ultrasound (complete) |
$5,360 |
$5,360 |
$1,179 |
$105 | |
| Pelvic ultrasound (limited) |
$1,431 |
$1,431 |
$343 |
$51 | |
| PET scan |
— |
— |
$2,127 |
— | |
| Phosphorus blood test |
$242 |
$242 |
$6 |
$5 | |
| Physical therapy evaluation |
$1,330 |
$1,330 |
$104 |
$98 | |
| Physical therapy evaluation (high complexity) |
$1,330 |
$1,330 |
$104 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$1,330 |
$1,330 |
$104 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$6,802 |
$541 | |
| Platelet count |
$356 |
$356 |
$5 |
$4 | |
| Pneumonia vaccine |
$529 |
$529 |
$159 |
— | |
| Pregnancy ultrasound |
$1,229 |
$1,229 |
$295 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$1,229 |
$1,229 |
$295 |
$117 | |
| Pregnancy ultrasound (second or third trimester) |
$1,229 |
$1,229 |
$295 |
$136 | |
| Procalcitonin test |
$74 |
$74 |
$27 |
$27 | |
| Prolactin test |
$108 |
$108 |
$21 |
$19 | |
| Prostate biopsy |
— |
— |
$3,120 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$15,556 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$11,754 |
$526 | |
| Prostate test (PSA) |
$117 |
$117 |
$20 |
$18 | |
| Psychiatric evaluation |
— |
— |
$173 |
$188 | |
| Psychotherapy session |
$555 |
$555 |
$122 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$6,802 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$246 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$6,802 |
$462 | |
| Retina scan (OCT) |
— |
— |
$120 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$154 |
$37 | |
| Retinal detachment repair |
— |
— |
$11,754 |
$966 | |
| Rheumatoid factor test |
— |
— |
$6 |
$6 | |
| Rotator cuff repair |
— |
— |
$10,737 |
$792 | |
| Routine eye exam |
— |
— |
$59 |
$88 | |
| RSV vaccine |
— |
— |
$632 |
— | |
| Sacroiliac joint injection |
— |
— |
$3,057 |
$176 | |
| Scoliosis spine X-ray |
— |
— |
$245 |
$58 | |
| Scoliosis spine X-ray (1 view) |
— |
— |
$182 |
$44 | |
| Scoliosis spine X-ray (3 views) |
— |
— |
$245 |
$72 | |
| Screening colonoscopy |
— |
— |
$2,194 |
$378 | |
| Screening mammogram |
$659 |
$659 |
$108 |
$126 | |
| Scrotal ultrasound |
$4,155 |
$4,155 |
$914 |
$99 | |
| Semen analysis |
— |
— |
$12 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$6,802 |
$613 | |
| Sex hormone binding globulin test |
$37 |
$37 |
$22 |
$22 | |
| Shingles vaccine |
— |
— |
$168 |
— | |
| Shoulder arthroscopy |
— |
— |
$11,754 |
$962 | |
| Shoulder replacement |
— |
— |
$6,802 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$2,750 |
$114 | |
| Simple wound stitches |
— |
— |
$2,750 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$11,456 |
$224 | |
| Skin biopsy |
— |
— |
$5,555 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$5,555 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$3,404 |
$240 | |
| Skin graft |
— |
— |
$6,802 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$3,057 |
$36 | |
| Skin tag removal |
— |
— |
$2,781 |
$92 | |
| Sleep study (polysomnography) |
— |
— |
$4,000 |
$691 | |
| Small bowel resection |
— |
— |
$6,802 |
$1,136 | |
| Soft tissue ultrasound |
— |
— |
$546 |
$64 | |
| Speech therapy |
$1,508 |
$1,508 |
$196 |
$76 | |
| Spinal cord stimulator |
— |
— |
$11,754 |
$2,388 | |
| Spinal tap (lumbar puncture) |
— |
— |
$3,339 |
$165 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$11,456 |
$5,803 | |
| Spirometry (lung function test) |
$590 |
$590 |
$130 |
$30 | |
| Spirometry with bronchodilator |
$4,195 |
$4,195 |
$881 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$11,456 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$6,802 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$6,802 |
$475 | |
| Strep throat test |
— |
— |
$17 |
$17 | |
| Stress echocardiogram (complete) |
— |
— |
$888 |
$233 | |
| Swallow study |
$2,028 |
$2,028 |
$250 |
$85 | |
| T3 thyroid test |
$546 |
$546 |
$17 |
$14 | |
| Tdap (tetanus) vaccine |
— |
— |
$65 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$6,802 |
$306 | |
| Testosterone test |
$145 |
$145 |
$28 |
$26 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$6,802 |
$1,004 | |
| Thyroid test (TSH) |
$322 |
$322 |
$20 |
$17 | |
| Thyroid ultrasound |
$5,238 |
$5,238 |
$1,152 |
$109 | |
| Thyroid uptake scan |
$6,034 |
$6,034 |
$1,653 |
$145 | |
| Tilt table test |
— |
— |
$6,826 |
$168 | |
| Tonsillectomy |
— |
— |
$6,802 |
$252 | |
| Total IgE allergy test |
$92 |
$92 |
$18 |
$16 | |
| Tracheostomy |
— |
— |
$6,802 |
$273 | |
| Transvaginal ultrasound |
$3,992 |
$3,992 |
$946 |
$118 | |
| Trigger finger release |
— |
— |
$6,208 |
$630 | |
| Trigger point injection |
— |
— |
$3,057 |
$56 | |
| Trigger point injection (1-2 muscles) |
— |
— |
$3,057 |
$52 | |
| Troponin (heart) test |
$262 |
$262 |
$15 |
$12 | |
| Tubal ligation |
— |
— |
$11,754 |
$333 | |
| Turbinate reduction |
— |
— |
$6,802 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$6,802 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$6,802 |
$575 | |
| Umbilical hernia repair |
— |
— |
$8,392 |
— | |
| Upper GI endoscopy (EGD) |
— |
— |
$3,339 |
$371 | |
| Ureteral stent placement |
— |
— |
$11,456 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$11,883 |
$365 | |
| Urine microalbumin test |
$79 |
$79 |
$6 |
$5 | |
| Urine pregnancy test |
$239 |
$239 |
$10 |
$9 | |
| UV light therapy (skin) |
— |
— |
$202 |
$106 | |
| Vaccine administration |
$267 |
$267 |
$61 |
$19 | |
| Vaccine administration (each additional) |
$267 |
$267 |
$58 |
$16 | |
| Vaginal delivery |
— |
— |
$8,192 |
$5,487 | |
| Varicocele repair |
— |
— |
$6,802 |
$327 | |
| Varicose vein ablation |
— |
— |
$6,802 |
$1,018 | |
| Vasectomy |
— |
— |
$6,802 |
$347 | |
| Visual field test |
— |
— |
$356 |
$64 | |
| Vitamin B12 test |
$185 |
$185 |
$17 |
$15 | |
| Vitamin D test |
$417 |
$417 |
$36 |
$30 | |
| Vitrectomy (eye) |
— |
— |
$11,754 |
$814 | |
| Vocal cord injection |
— |
— |
$6,802 |
$211 | |
| Wart removal |
— |
— |
$3,057 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$15,425 |
$11,645 | |
| Well-child visit |
— |
— |
$59 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$6,802 |
$2,871 | |
| Wound debridement |
— |
— |
$3,057 |
$186 | |
| Wrist fracture repair |
— |
— |
$6,802 |
$735 | |
| X-ray of the hip (1 view) |
$791 |
$791 |
$182 |
$34 | |
| X-ray of the ribs (3 views) |
$1,186 |
$1,186 |
$273 |
$42 | |
| X-ray of the thigh bone |
— |
— |
$580 |
— | |
| YAG laser capsulotomy (eye) |
— |
— |
$3,473 |
$335 | |
| Zinc blood test |
$111 |
$111 |
$13 |
$11 | |