| 3D mammogram (tomosynthesis) |
$136 |
$136 |
$87 |
$51 | |
| Abdominal fluid drain (paracentesis) |
— |
— |
$2,229 |
$284 | |
| Abscess drainage (complex or multiple) |
— |
— |
$2,017 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$2,017 |
$129 | |
| Abscess incision and drainage |
— |
— |
$2,017 |
$174 | |
| Achilles tendon repair |
— |
— |
$4,145 |
$624 | |
| ACL knee reconstruction |
— |
— |
$6,300 |
$889 | |
| Acupuncture |
— |
— |
$77 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$67 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$3,878 |
$204 | |
| Allergy patch testing |
— |
— |
$2,345 |
$5 | |
| Allergy shots |
— |
— |
$98 |
$11 | |
| Allergy testing |
— |
— |
$2,345 |
$4 | |
| Amniocentesis |
— |
— |
$2,017 |
$120 | |
| Anal fistula repair |
— |
— |
$3,751 |
$541 | |
| Ankle fracture repair |
— |
— |
$4,034 |
$608 | |
| Ankle replacement |
— |
— |
$4,360 |
$885 | |
| Annual physical (established patient) |
— |
— |
$270 |
— | |
| Annual physical (new patient) |
— |
— |
$312 |
— | |
| Anoscopy |
— |
— |
$2,115 |
$129 | |
| Antinuclear antibody (ANA) test |
$107 |
$107 |
$50 |
$12 | |
| Aortic valve replacement |
$122,043 |
$122,043 |
$9,000 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$20,290 |
$592 | |
| Bartholin cyst removal |
— |
— |
$2,017 |
$182 | |
| Benign skin lesion removal |
— |
— |
$2,017 |
$171 | |
| Bladder function test (urodynamics) |
$2,389 |
$2,389 |
$2,017 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$2,128 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$3,486 |
$236 | |
| Blood crossmatch |
$430 |
$430 |
$152 |
— | |
| Blood transfusion |
$2,133 |
$2,133 |
$866 |
$47 | |
| Blood type test |
$296 |
$296 |
$14 |
$3 | |
| Blood type test (ABO group) |
$258 |
$258 |
$14 |
$3 | |
| Blood type test (Rh/D antigen) |
$379 |
$379 |
$14 |
$3 | |
| BNP (heart failure) test |
$1,430 |
$1,430 |
$175 |
$39 | |
| Bone density scan (DEXA) |
$2,568 |
$2,568 |
$113 |
$39 | |
| Bone marrow biopsy |
— |
— |
$2,221 |
$172 | |
| Bone scan (nuclear) |
$10,565 |
$10,565 |
$717 |
$259 | |
| Botox for migraine |
— |
— |
$2,017 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$8,757 |
$1,023 | |
| Breast biopsy |
— |
— |
$2,613 |
$478 | |
| Breast MRI |
$14,794 |
$14,794 |
$1,923 |
$216 | |
| Breast MRI without contrast |
— |
— |
$1,605 |
$216 | |
| Breast reconstruction |
— |
— |
$5,142 |
$1,227 | |
| Breast reduction |
— |
— |
$4,226 |
$980 | |
| Breast ultrasound |
$2,826 |
$2,826 |
$876 |
$92 | |
| Breast ultrasound (complete) |
$2,826 |
$2,826 |
$989 |
$100 | |
| Breast ultrasound (limited) |
$1,976 |
$1,976 |
$692 |
$84 | |
| Breathing tube insertion (intubation) |
— |
— |
$2,017 |
$133 | |
| Bronchoscopy |
— |
— |
$2,613 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$4,255 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$2,229 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$2,017 |
$93 | |
| Burn treatment |
— |
— |
$2,107 |
$129 | |
| CA 19-9 tumor marker test |
$877 |
$877 |
$85 |
$21 | |
| CA-125 ovarian marker test |
$901 |
$901 |
$85 |
$21 | |
| Capsule endoscopy |
— |
— |
$2,030 |
$802 | |
| Cardiac ablation |
$104,364 |
$104,364 |
$32,696 |
$759 | |
| Cardiac catheterization |
$35,370 |
$35,370 |
$10,260 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$664 |
$170 | |
| Cardiac MRI |
$15,334 |
$15,334 |
$828 |
$322 | |
| Cardiac MRI without contrast |
$12,857 |
$12,857 |
$518 |
$280 | |
| Cardiac rehabilitation |
$794 |
$794 |
$186 |
$26 | |
| Cardiac stress test |
$6,073 |
$6,073 |
$1,439 |
$39 | |
| Cardioversion |
$5,384 |
$5,384 |
$1,349 |
$155 | |
| Carotid artery surgery |
— |
— |
$8,757 |
$1,026 | |
| Carotid artery ultrasound |
$7,441 |
$7,441 |
$603 |
$156 | |
| Carpal tunnel release |
— |
— |
$2,915 |
$483 | |
| Cataract surgery |
— |
— |
$4,052 |
$547 | |
| Celiac disease test |
— |
— |
$12 |
$12 | |
| Central line placement |
— |
— |
$2,434 |
$238 | |
| Cervical cerclage |
— |
— |
$2,727 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$3,041 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$10,299 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$2,017 |
$131 | |
| Chemotherapy infusion |
$794 |
$794 |
$300 |
$81 | |
| Chemotherapy infusion (each additional) |
$736 |
$736 |
$143 |
$28 | |
| Chemotherapy infusion (first hour) |
$1,730 |
$1,730 |
$462 |
$133 | |
| Chest fluid drain (thoracentesis) |
— |
— |
$2,066 |
$311 | |
| Chest tube insertion |
— |
— |
$2,428 |
$143 | |
| Chest X-ray |
$2,022 |
$2,022 |
$196 |
$37 | |
| Chest X-ray (1 view) |
$1,849 |
$1,849 |
$168 |
$25 | |
| Chest X-ray (2 views) |
$2,022 |
$2,022 |
$182 |
$33 | |
| Chickenpox (varicella) vaccine |
— |
— |
$380 |
— | |
| Chiropractic adjustment |
— |
— |
$63 |
$38 | |
| Circumcision |
— |
— |
$2,834 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$8,104 |
$1,238 | |
| Colonoscopy |
— |
— |
$2,431 |
$480 | |
| Colostomy |
— |
— |
$8,757 |
$1,122 | |
| Colposcopy |
— |
— |
$2,017 |
$161 | |
| Complete blood count (CBC) (complete) |
— |
— |
$23 |
$8 | |
| Complex wound repair |
— |
— |
$2,661 |
$390 | |
| Comprehensive eye exam |
— |
— |
$374 |
$138 | |
| Contact lens fitting |
— |
— |
$197 |
— | |
| Continuous glucose monitor setup |
— |
— |
$118 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$2,017 |
$115 | |
| Corneal transplant |
— |
— |
$4,740 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$35,296 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$47,505 |
$36,593 | |
| Coronary CT angiography |
$11,305 |
$11,305 |
$402 |
$326 | |
| COVID-19 PCR test |
$64 |
$64 |
$51 |
$51 | |
| Craniotomy (brain surgery) |
— |
— |
$8,757 |
$2,161 | |
| CT angiography of the chest |
$14,154 |
$14,154 |
$2,106 |
$281 | |
| CT angiography of the head |
$12,805 |
$12,805 |
$2,254 |
$274 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$1,561 |
$835 | |
| CT scan of the abdomen |
$12,759 |
$12,759 |
$1,708 |
$230 | |
| CT scan of the abdomen and pelvis |
$23,377 |
$23,377 |
$3,107 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$28,447 |
$28,447 |
$2,106 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$23,377 |
$23,377 |
$3,864 |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$18,717 |
$18,717 |
$1,987 |
$183 | |
| CT scan of the abdomen with and without contrast |
$15,825 |
$15,825 |
$2,106 |
$259 | |
| CT scan of the abdomen with contrast |
$12,759 |
$12,759 |
$2,106 |
$230 | |
| CT scan of the abdomen without contrast |
$9,706 |
$9,706 |
$1,577 |
$136 | |
| CT scan of the arm |
$7,069 |
$7,069 |
$2,267 |
$199 | |
| CT scan of the arm with contrast |
$7,069 |
$7,069 |
$2,828 |
$199 | |
| CT scan of the arm without contrast |
$5,297 |
$5,297 |
$2,267 |
$161 | |
| CT scan of the chest |
$13,068 |
$13,068 |
$1,771 |
$167 | |
| CT scan of the chest with and without contrast |
$15,523 |
$15,523 |
$1,635 |
$196 | |
| CT scan of the chest with contrast |
$13,068 |
$13,068 |
$2,106 |
$167 | |
| CT scan of the chest without contrast |
$9,461 |
$9,461 |
$1,665 |
$133 | |
| CT scan of the head |
$9,710 |
$9,710 |
$1,612 |
$148 | |
| CT scan of the head with and without contrast |
$13,092 |
$13,092 |
$1,635 |
$173 | |
| CT scan of the head with contrast |
$9,710 |
$9,710 |
$1,709 |
$148 | |
| CT scan of the head without contrast |
$8,594 |
$8,594 |
$1,301 |
$107 | |
| CT scan of the leg |
$6,799 |
$6,799 |
$2,591 |
$166 | |
| CT scan of the leg with contrast |
$6,799 |
$6,799 |
$2,938 |
$166 | |
| CT scan of the leg without contrast |
$6,532 |
$6,532 |
$2,809 |
$130 | |
| CT scan of the lower back (lumbar spine) |
$14,287 |
$14,287 |
$1,301 |
$169 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
— |
— |
$194 |
$197 | |
| CT scan of the lower back (lumbar spine) with contrast |
$14,648 |
$14,648 |
$2,106 |
$169 | |
| CT scan of the neck |
$10,072 |
$10,072 |
$1,771 |
$183 | |
| CT scan of the neck (cervical spine) |
$12,137 |
$12,137 |
$1,301 |
$168 | |
| CT scan of the neck (cervical spine) with and without contrast |
— |
— |
$194 |
$196 | |
| CT scan of the neck (cervical spine) with contrast |
$12,874 |
$12,874 |
$2,106 |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$11,401 |
$11,401 |
$1,893 |
$131 | |
| CT scan of the neck with and without contrast |
$11,048 |
$11,048 |
$1,834 |
$220 | |
| CT scan of the neck with contrast |
$10,072 |
$10,072 |
$1,771 |
$183 | |
| CT scan of the neck without contrast |
$9,342 |
$9,342 |
$1,644 |
$150 | |
| CT scan of the pelvis |
$10,620 |
$10,620 |
$1,635 |
$226 | |
| CT scan of the pelvis with and without contrast |
$12,628 |
$12,628 |
$2,096 |
$251 | |
| CT scan of the pelvis with contrast |
$10,620 |
$10,620 |
$1,771 |
$226 | |
| CT scan of the pelvis without contrast |
$9,011 |
$9,011 |
$1,602 |
$133 | |
| CT scan of the sinuses |
$11,008 |
$11,008 |
$1,689 |
$152 | |
| CT scan of the sinuses with and without contrast |
$11,770 |
$11,770 |
$1,635 |
$184 | |
| CT scan of the sinuses with contrast |
$11,008 |
$11,008 |
$1,827 |
$152 | |
| CT scan of the sinuses without contrast |
$9,050 |
$9,050 |
$1,635 |
$128 | |
| D-dimer test |
— |
— |
$30 |
$10 | |
| Defibrillator (ICD) implant |
$103,442 |
$103,442 |
$5,120 |
$798 | |
| Developmental screening (child) |
— |
— |
$33 |
— | |
| Diagnostic mammogram |
$2,613 |
$2,613 |
$528 |
$140 | |
| Dialysis fistula creation |
— |
— |
$4,034 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$3,041 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$3,870 |
$745 | |
| Drug screen (urine) |
$264 |
$264 |
$66 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$108 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$2,742 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$4,416 |
$799 | |
| Echocardiogram with and without contrast |
$3,311 |
$3,311 |
$199 |
$101 | |
| Echocardiogram without contrast |
— |
— |
$143 |
$138 | |
| EEG (awake and asleep) |
$3,591 |
$3,591 |
$954 |
$482 | |
| Elbow replacement |
— |
— |
$4,742 |
$1,301 | |
| Electroencephalogram (EEG) |
$1,590 |
$1,590 |
$822 |
$448 | |
| Electromyography (EMG) |
— |
— |
$352 |
$141 | |
| Emergency department visit |
$2,772 |
$2,772 |
$1,177 |
$69 | |
| Emergency department visit (level 1) |
$732 |
$732 |
$430 |
$11 | |
| Emergency department visit (level 2) |
$1,941 |
$1,941 |
$973 |
$40 | |
| Emergency department visit (level 3) |
$2,772 |
$2,772 |
$1,500 |
$69 | |
| Emergency department visit (level 4) |
$3,909 |
$3,909 |
$2,345 |
$118 | |
| Emergency department visit (level 5) |
$5,616 |
$5,616 |
$3,514 |
$171 | |
| Endometrial biopsy |
— |
— |
$2,017 |
$98 | |
| Epidural steroid injection |
— |
— |
$2,017 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$3,041 |
$311 | |
| Esophageal dilation |
— |
— |
$2,374 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,434 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$64 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$3,148 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$2,155 |
$99 | |
| Fallopian tube X-ray (HSG) |
$4,921 |
$4,921 |
$974 |
$164 | |
| Family therapy session |
— |
— |
$36 |
$110 | |
| Feeding tube (PEG) placement |
— |
— |
$2,552 |
$178 | |
| Femoral hernia repair |
— |
— |
$4,255 |
$584 | |
| Fibroid removal (myomectomy) |
— |
— |
$4,988 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$2,128 |
$323 | |
| Flu vaccine |
— |
— |
$49 |
— | |
| Foreign body removal (skin) |
— |
— |
$2,017 |
$157 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$6,300 |
$658 | |
| Gallbladder scan (HIDA) |
$11,976 |
$11,976 |
$765 |
$334 | |
| Ganglion cyst removal |
— |
— |
$3,228 |
$321 | |
| Glaucoma surgery |
— |
— |
$3,660 |
$984 | |
| Group therapy session |
$419 |
$419 |
$103 |
$30 | |
| H. pylori test |
— |
— |
$202 |
$67 | |
| Hammertoe repair |
— |
— |
$3,732 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$364 |
$36 | |
| Hemodialysis |
$3,520 |
$3,520 |
$1,023 |
$75 | |
| Hemorrhoid removal |
— |
— |
$2,317 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$121 |
— | |
| Hepatitis B vaccine |
$136 |
$136 |
$110 |
— | |
| Hip arthroscopy |
— |
— |
$6,300 |
$931 | |
| Hip fracture repair |
— |
— |
$4,250 |
$1,120 | |
| Hip replacement |
— |
— |
$4,360 |
$1,162 | |
| HIV test (antigen/antibody combo) |
— |
— |
$72 |
$24 | |
| Holter heart monitor |
$3,509 |
$3,509 |
$378 |
$26 | |
| Home sleep apnea test |
— |
— |
$724 |
$123 | |
| HPV vaccine |
— |
— |
$651 |
— | |
| Hydrocele repair |
— |
— |
$4,145 |
$315 | |
| Hysterectomy |
— |
— |
$5,563 |
$933 | |
| Hysteroscopy |
— |
— |
$4,690 |
$1,270 | |
| Ileostomy |
— |
— |
$8,757 |
$968 | |
| Incisional hernia repair |
— |
— |
$6,077 |
— | |
| Inguinal hernia repair |
— |
— |
$4,255 |
$538 | |
| IUD insertion |
— |
— |
$2,115 |
— | |
| IUD removal |
— |
— |
$2,017 |
$112 | |
| IV infusion therapy |
$417 |
$417 |
$159 |
$44 | |
| IV infusion therapy (each additional) |
$163 |
$163 |
$50 |
$21 | |
| IV infusion therapy (initial) |
$1,374 |
$1,374 |
$441 |
$67 | |
| IVC filter placement |
$17,279 |
$17,279 |
$4,690 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$2,017 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
— |
— |
$2,017 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$2,017 |
$56 | |
| Kidney biopsy |
— |
— |
$2,431 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$8,757 |
$1,164 | |
| Kidney scan (nuclear) |
$9,960 |
$9,960 |
$598 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$6,248 |
$760 | |
| Kidney ultrasound (limited) |
$4,085 |
$4,085 |
$719 |
$61 | |
| Knee arthroscopy |
— |
— |
$4,973 |
$524 | |
| Knee joint injection |
— |
— |
$2,017 |
$69 | |
| Knee replacement |
— |
— |
$23,701 |
$18,054 | |
| Laminectomy (spine) |
— |
— |
$4,250 |
$1,157 | |
| Laryngoscopy |
— |
— |
$2,428 |
$189 | |
| LDL cholesterol test |
— |
— |
$31 |
$11 | |
| Leg artery angiogram |
$9,911 |
$9,911 |
$1,568 |
$149 | |
| Leg artery angioplasty |
$39,064 |
$39,064 |
$4,690 |
— | |
| Leg vein ultrasound (Doppler) |
$5,033 |
$5,033 |
$612 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$1,205 |
$1,205 |
$460 |
$116 | |
| Liver biopsy |
— |
— |
$2,431 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$69,715 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$4,250 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$4,390 |
$750 | |
| Lung function test (PFT) |
$3,003 |
$3,003 |
$920 |
$37 | |
| Mastectomy |
— |
— |
$4,255 |
$1,021 | |
| Mastoidectomy |
— |
— |
$4,540 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$4,973 |
$714 | |
| MMR vaccine |
$519 |
$519 |
$193 |
— | |
| Mohs skin cancer surgery |
— |
— |
$2,299 |
$535 | |
| MRA of the brain |
$14,793 |
$14,793 |
$828 |
$226 | |
| MRA of the brain with contrast |
$14,793 |
$14,793 |
$828 |
$226 | |
| MRA of the brain without contrast |
$20,489 |
$20,489 |
$828 |
$328 | |
| MRA of the neck |
$14,793 |
$14,793 |
$828 |
$245 | |
| MRA of the neck with contrast |
$14,793 |
$14,793 |
$828 |
$245 | |
| MRA of the neck without contrast |
$20,489 |
$20,489 |
$828 |
$343 | |
| MRI of the abdomen |
$14,793 |
$14,793 |
$828 |
$300 | |
| MRI of the abdomen with contrast |
$14,793 |
$14,793 |
$828 |
$300 | |
| MRI of the abdomen without contrast |
$14,793 |
$14,793 |
$518 |
$194 | |
| MRI of the ankle |
$20,489 |
$20,489 |
$2,127 |
$261 | |
| MRI of the ankle with contrast |
$17,842 |
$17,842 |
$1,706 |
$261 | |
| MRI of the ankle without contrast |
$17,565 |
$17,565 |
$2,107 |
$222 | |
| MRI of the brain |
$14,794 |
$14,794 |
$888 |
$269 | |
| MRI of the brain with contrast |
$14,793 |
$14,793 |
$1,256 |
$269 | |
| MRI of the brain without contrast |
$14,794 |
$14,794 |
$918 |
$195 | |
| MRI of the chest |
$14,794 |
$14,794 |
$1,229 |
$371 | |
| MRI of the chest with contrast |
— |
— |
$1,359 |
$371 | |
| MRI of the chest without contrast |
$20,489 |
$20,489 |
$1,265 |
$466 | |
| MRI of the knee |
$19,166 |
$19,166 |
$1,706 |
$315 | |
| MRI of the knee with contrast |
$17,842 |
$17,842 |
$1,609 |
$315 | |
| MRI of the knee without contrast |
$17,565 |
$17,565 |
$2,107 |
$204 | |
| MRI of the lower back (lumbar spine) |
$14,794 |
$14,794 |
$888 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$14,793 |
$14,793 |
$828 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$14,794 |
$14,794 |
$518 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$14,793 |
$14,793 |
$828 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$20,489 |
$20,489 |
$828 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$14,793 |
$14,793 |
$828 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$14,793 |
$14,793 |
$518 |
$190 | |
| MRI of the neck (cervical spine) |
$14,793 |
$14,793 |
$828 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$20,489 |
$20,489 |
$828 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$14,793 |
$14,793 |
$828 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$14,793 |
$14,793 |
$518 |
$191 | |
| MRI of the pelvis |
$14,793 |
$14,793 |
$828 |
$268 | |
| MRI of the pelvis with contrast |
$6,681 |
$6,681 |
$828 |
$268 | |
| MRI of the pelvis without contrast |
$14,793 |
$14,793 |
$518 |
$227 | |
| MRI of the shoulder |
$17,842 |
$17,842 |
$1,609 |
$313 | |
| MRI of the shoulder with contrast |
$17,842 |
$17,842 |
$1,609 |
$313 | |
| MRI of the shoulder without contrast |
$17,565 |
$17,565 |
$1,054 |
$205 | |
| MRI of the wrist |
$20,489 |
$20,489 |
$2,117 |
$330 | |
| MRI of the wrist without contrast |
$17,565 |
$17,565 |
$2,107 |
$303 | |
| Nebulizer breathing treatment |
$843 |
$843 |
$338 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$4,690 |
$1,410 | |
| Nerve conduction study |
— |
— |
$185 |
$118 | |
| Newborn hospital care |
— |
— |
$337 |
$58 | |
| Nuclear cardiac stress test |
$22,348 |
$22,348 |
$1,445 |
$428 | |
| Occupational therapy evaluation |
$1,044 |
$1,044 |
$124 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$1,130 |
$1,130 |
$129 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$956 |
$956 |
$124 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$1,044 |
$1,044 |
$129 |
$101 | |
| Office visit (established patient) |
$646 |
$646 |
$252 |
$115 | |
| Office visit (new patient) |
$885 |
$885 |
$351 |
$177 | |
| Office visit, established patient (level 3) |
$566 |
$566 |
$204 |
$95 | |
| Office visit, established patient (level 4) |
$928 |
$928 |
$300 |
$136 | |
| Office visit, new patient (level 3) |
$724 |
$724 |
$267 |
$118 | |
| Office visit, new patient (level 4) |
$1,219 |
$1,219 |
$409 |
$177 | |
| Office visit, new patient (level 5) |
$1,211 |
$1,211 |
$424 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$3,605 |
$632 | |
| Ovarian cyst removal |
— |
— |
$4,577 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$4,760 |
$822 | |
| Pacemaker insertion |
— |
— |
$20,085 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$84 |
$20 | |
| Parathyroid removal |
— |
— |
$4,690 |
$891 | |
| Pelvic ultrasound (limited) |
— |
— |
$52 |
$51 | |
| PET scan |
$37,516 |
$37,516 |
$2,209 |
— | |
| Physical therapy evaluation |
$1,044 |
$1,044 |
$136 |
$98 | |
| Physical therapy evaluation (high complexity) |
$1,130 |
$1,130 |
$147 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$1,044 |
$1,044 |
$136 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$3,493 |
$541 | |
| Pneumonia vaccine |
$804 |
$804 |
$220 |
— | |
| Procalcitonin test |
$305 |
$305 |
$112 |
$27 | |
| Prostate biopsy |
— |
— |
$2,832 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$11,200 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$4,226 |
$526 | |
| Prostate test (PSA) |
$922 |
$922 |
$75 |
$18 | |
| Psychiatric evaluation |
— |
— |
$76 |
$188 | |
| Psychotherapy session |
— |
— |
$39 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$3,041 |
$540 | |
| Pulmonary rehabilitation |
$525 |
$525 |
$180 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$2,727 |
$462 | |
| Retina scan (OCT) |
— |
— |
$144 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$328 |
$37 | |
| Retinal detachment repair |
— |
— |
$4,690 |
$966 | |
| Rotator cuff repair |
— |
— |
$4,742 |
$792 | |
| Routine eye exam |
— |
— |
$329 |
$88 | |
| RSV vaccine |
— |
— |
$632 |
— | |
| Sacroiliac joint injection |
— |
— |
$2,115 |
$176 | |
| Scoliosis spine X-ray (3 views) |
$3,135 |
$3,135 |
$259 |
$72 | |
| Screening colonoscopy |
— |
— |
$2,229 |
$378 | |
| Screening mammogram |
$1,305 |
$1,305 |
$366 |
$126 | |
| Scrotal ultrasound |
$4,989 |
$4,989 |
$878 |
$99 | |
| Septoplasty (deviated septum) |
— |
— |
$3,886 |
$613 | |
| Shingles vaccine |
— |
— |
$456 |
— | |
| Shoulder arthroscopy |
— |
— |
$5,592 |
$962 | |
| Shoulder replacement |
— |
— |
$4,250 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$2,115 |
$114 | |
| Simple wound stitches |
— |
— |
$2,017 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$3,732 |
$224 | |
| Skin biopsy |
— |
— |
$2,017 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$2,017 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$2,017 |
$240 | |
| Skin graft |
— |
— |
$2,876 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$2,181 |
$36 | |
| Skin tag removal |
— |
— |
$2,115 |
$92 | |
| Small bowel resection |
— |
— |
$8,757 |
$1,136 | |
| Speech therapy |
$741 |
$741 |
$130 |
$76 | |
| Spinal cord stimulator |
— |
— |
$4,255 |
$2,388 | |
| Spinal tap (lumbar puncture) |
— |
— |
$2,128 |
$165 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$4,255 |
$5,803 | |
| Spirometry with bronchodilator |
$3,377 |
$3,377 |
$1,155 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$8,778 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$8,757 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$3,870 |
$475 | |
| Strep throat test |
— |
— |
$49 |
$17 | |
| Stress echocardiogram |
$7,060 |
$7,060 |
$384 |
$209 | |
| Stress echocardiogram (complete) |
— |
— |
$483 |
$233 | |
| Swallow study |
$801 |
$801 |
$192 |
$85 | |
| Tdap (tetanus) vaccine |
$117 |
$117 |
$50 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$4,145 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$4,740 |
$1,004 | |
| Tilt table test |
$1,831 |
$1,831 |
$1,600 |
$168 | |
| Tonsillectomy |
— |
— |
$3,934 |
$252 | |
| Tracheostomy |
— |
— |
$3,041 |
$273 | |
| Transesophageal echocardiogram (TEE) |
$6,277 |
$6,277 |
$395 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
$7,411 |
$7,411 |
$445 |
$239 | |
| Transvaginal ultrasound |
$4,771 |
$4,771 |
$1,522 |
$118 | |
| Trigger finger release |
— |
— |
$2,613 |
$630 | |
| Trigger point injection |
— |
— |
$2,017 |
$56 | |
| Trigger point injection (1-2 muscles) |
— |
— |
$2,017 |
$52 | |
| Tubal ligation |
— |
— |
$5,592 |
$333 | |
| Turbinate reduction |
— |
— |
$3,041 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$4,255 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$2,915 |
$575 | |
| Umbilical hernia repair |
— |
— |
$6,077 |
— | |
| Upper GI endoscopy (EGD) |
— |
— |
$2,346 |
$371 | |
| Upper GI series (barium) |
$4,193 |
$4,193 |
$376 |
$128 | |
| Ureteral stent placement |
— |
— |
$3,041 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$4,042 |
$365 | |
| Uric acid (gout) test |
— |
— |
$14 |
$5 | |
| UV light therapy (skin) |
— |
— |
$178 |
$106 | |
| Vaccine administration |
$377 |
$377 |
$138 |
$19 | |
| Vaccine administration (each additional) |
$377 |
$377 |
$132 |
$16 | |
| Vaginal delivery |
— |
— |
$7,933 |
$5,487 | |
| Varicocele repair |
— |
— |
$3,878 |
$327 | |
| Varicose vein ablation |
$10,022 |
$10,022 |
$4,255 |
$1,018 | |
| Vasectomy |
— |
— |
$2,915 |
$347 | |
| Visual field test |
— |
— |
$338 |
$64 | |
| Vitamin D test |
$1,050 |
$1,050 |
$121 |
$30 | |
| Vitrectomy (eye) |
— |
— |
$4,690 |
$814 | |
| Vocal cord injection |
— |
— |
$3,041 |
$211 | |
| Wart removal |
— |
— |
$2,115 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$13,250 |
$11,645 | |
| Well-child visit |
— |
— |
$230 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$8,757 |
$2,871 | |
| Wound debridement |
— |
— |
$2,229 |
$186 | |
| Wrist fracture repair |
— |
— |
$4,462 |
$735 | |
| X-ray of the abdomen |
$2,562 |
$2,562 |
$207 |
$36 | |
| X-ray of the ankle |
$2,164 |
$2,164 |
$757 |
$37 | |
| X-ray of the collarbone |
$2,022 |
$2,022 |
$708 |
$33 | |
| X-ray of the elbow |
$2,556 |
$2,556 |
$895 |
$33 | |
| X-ray of the facial bones |
$2,497 |
$2,497 |
$207 |
$39 | |
| X-ray of the foot |
$1,984 |
$1,984 |
$694 |
$34 | |
| X-ray of the forearm |
$1,753 |
$1,753 |
$614 |
$29 | |
| X-ray of the hand |
$1,753 |
$1,753 |
$614 |
$38 | |
| X-ray of the hip (4 views) |
$2,786 |
$2,786 |
$217 |
$63 | |
| X-ray of the knee (2 views) |
$1,920 |
$1,920 |
$672 |
$34 | |
| X-ray of the knee (4+ views) |
— |
— |
$140 |
$49 | |
| X-ray of the lower back (lumbar spine) |
$3,264 |
$3,264 |
$248 |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$2,352 |
$2,352 |
$245 |
$40 | |
| X-ray of the neck (cervical spine) (3 views) |
$2,599 |
$2,599 |
$182 |
$40 | |
| X-ray of the pelvis |
$2,391 |
$2,391 |
$142 |
$36 | |
| X-ray of the ribs (2 views) |
$2,412 |
$2,412 |
$579 |
$36 | |
| X-ray of the shoulder |
$2,737 |
$2,737 |
$958 |
$36 | |
| X-ray of the upper arm |
$2,022 |
$2,022 |
$708 |
$32 | |
| X-ray of the wrist |
$2,104 |
$2,104 |
$736 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$2,229 |
$335 | |