| 3D mammogram (tomosynthesis) |
$67 |
$67 |
$23 |
$51 | |
| Abdominal fluid drain (paracentesis) |
— |
— |
$2,675 |
$284 | |
| Abdominal ultrasound |
$1,600 |
$1,600 |
$698 |
$100 | |
| Abdominal ultrasound (complete) |
$1,946 |
$1,946 |
$870 |
$114 | |
| Abdominal ultrasound (limited) |
$1,254 |
$1,254 |
$561 |
$86 | |
| Abscess drainage (complex or multiple) |
— |
— |
$2,675 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$2,675 |
$129 | |
| Abscess incision and drainage |
— |
— |
$2,675 |
$174 | |
| Achilles tendon repair |
— |
— |
$2,675 |
$624 | |
| ACL knee reconstruction |
— |
— |
$5,198 |
$889 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$2,675 |
$204 | |
| Albumin blood test |
— |
— |
$6 |
$5 | |
| Aldosterone test |
— |
— |
$53 |
$41 | |
| Alkaline phosphatase test |
— |
— |
$7 |
$5 | |
| Allergy shots |
$138 |
$138 |
$63 |
$11 | |
| Alpha-fetoprotein (AFP) test |
— |
— |
$22 |
$17 | |
| ALT liver enzyme test |
— |
— |
$7 |
$5 | |
| Ammonia blood test |
— |
— |
$19 |
$15 | |
| Amniocentesis |
— |
— |
$2,675 |
$120 | |
| Amylase test |
— |
— |
$8 |
$6 | |
| Anal fistula repair |
— |
— |
$2,675 |
$541 | |
| Ankle fracture repair |
— |
— |
$2,675 |
$608 | |
| Ankle replacement |
— |
— |
$14,000 |
$885 | |
| Anoscopy |
— |
— |
$2,675 |
$129 | |
| Antinuclear antibody (ANA) test |
— |
— |
$16 |
$12 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$2,675 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$2,675 |
$1,603 | |
| Arterial blood gas (ABG) |
$312 |
$312 |
$140 |
$26 | |
| AST liver enzyme test |
— |
— |
$7 |
$5 | |
| Barium swallow study |
$869 |
$869 |
$389 |
$107 | |
| Bartholin cyst removal |
— |
— |
$2,675 |
$182 | |
| Basic metabolic panel |
— |
— |
$10 |
$8 | |
| Benign skin lesion removal |
— |
— |
$2,675 |
$171 | |
| Bilirubin blood test |
— |
— |
$7 |
$5 | |
| Bladder function test (urodynamics) |
— |
— |
$2,675 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$5,198 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$5,198 |
$236 | |
| Blood clotting test (PT/INR) |
$5 |
$5 |
$2 |
$4 | |
| Blood glucose test |
$40 |
$40 |
$18 |
$5 | |
| Blood transfusion |
$1,101 |
$1,101 |
$621 |
$47 | |
| Blood type and screen |
— |
— |
$15 |
$10 | |
| Blood type test |
— |
— |
$4 |
$3 | |
| Blood type test (ABO group) |
— |
— |
$4 |
$3 | |
| Blood type test (Rh/D antigen) |
— |
— |
$4 |
$3 | |
| BNP (heart failure) test |
— |
— |
$44 |
$39 | |
| Bone density scan (DEXA) |
$254 |
$254 |
$113 |
$39 | |
| Bone marrow biopsy |
— |
— |
$2,675 |
$172 | |
| Botox for migraine |
— |
— |
$2,675 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$2,675 |
$1,023 | |
| Breast biopsy |
— |
— |
$2,675 |
$478 | |
| Breast reconstruction |
— |
— |
$5,198 |
$1,227 | |
| Breast reduction |
— |
— |
$5,198 |
$980 | |
| Breast ultrasound |
$655 |
$655 |
$393 |
$92 | |
| Breast ultrasound (limited) |
$655 |
$655 |
$393 |
$84 | |
| Breathing tube insertion (intubation) |
— |
— |
$2,675 |
$133 | |
| Bronchoscopy |
— |
— |
$2,675 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$5,198 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$2,675 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$2,675 |
$93 | |
| Burn treatment |
— |
— |
$2,675 |
$129 | |
| C-reactive protein (CRP) |
— |
— |
$7 |
$5 | |
| CA 19-9 tumor marker test |
— |
— |
$27 |
$21 | |
| CA-125 ovarian marker test |
— |
— |
$27 |
$21 | |
| Calcium blood test |
— |
— |
$7 |
$5 | |
| Cardiac catheterization |
— |
— |
$4,043 |
$1,049 | |
| Cardiac rehabilitation |
$459 |
$459 |
$190 |
$26 | |
| Cardiac stress test |
$968 |
$968 |
$426 |
$39 | |
| Cardioversion |
$5,915 |
$5,915 |
$2,729 |
$155 | |
| Carotid artery surgery |
— |
— |
$2,675 |
$1,026 | |
| Carotid artery ultrasound |
$2,091 |
$2,091 |
$871 |
$156 | |
| Carpal tunnel release |
— |
— |
$5,198 |
$483 | |
| Cataract surgery |
— |
— |
$2,675 |
$547 | |
| CEA tumor marker test |
— |
— |
$25 |
$19 | |
| Celiac disease test |
— |
— |
$11 |
$12 | |
| Central line placement |
— |
— |
$2,675 |
$238 | |
| Cervical cerclage |
— |
— |
$2,675 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$2,675 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$1,592 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$2,675 |
$131 | |
| Chemotherapy infusion |
$433 |
$433 |
$121 |
$81 | |
| Chemotherapy infusion (each additional) |
$98 |
$98 |
$44 |
$28 | |
| Chemotherapy infusion (first hour) |
$767 |
$767 |
$343 |
$133 | |
| Chest fluid drain (thoracentesis) |
— |
— |
$2,675 |
$311 | |
| Chest tube insertion |
— |
— |
$2,675 |
$143 | |
| Chest X-ray |
$626 |
$626 |
$274 |
$37 | |
| Chest X-ray (1 view) |
$557 |
$557 |
$249 |
$25 | |
| Chest X-ray (2 views) |
$655 |
$655 |
$293 |
$33 | |
| Chickenpox (varicella) vaccine |
$882 |
$882 |
$404 |
— | |
| Circumcision |
— |
— |
$3,875 |
$167 | |
| CK-MB heart enzyme test |
— |
— |
$15 |
$12 | |
| Clotting time test (PTT) |
— |
— |
$8 |
$6 | |
| Colon resection (colectomy) |
— |
— |
$3,875 |
$1,238 | |
| Colonoscopy |
— |
— |
$2,675 |
$480 | |
| Colostomy |
— |
— |
$2,675 |
$1,122 | |
| Colposcopy |
— |
— |
$2,675 |
$161 | |
| Complete blood count (CBC) |
— |
— |
$9 |
$7 | |
| Complete blood count (CBC) (complete) |
— |
— |
$10 |
$8 | |
| Complex wound repair |
— |
— |
$2,675 |
$390 | |
| Comprehensive metabolic panel |
— |
— |
$11 |
$11 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$2,675 |
$115 | |
| Copper blood test |
— |
— |
$16 |
$12 | |
| Corneal transplant |
— |
— |
$2,675 |
$1,066 | |
| Coronary artery bypass (CABG) |
— |
— |
$1,592 |
$36,593 | |
| Cortisol test |
— |
— |
$21 |
$16 | |
| COVID-19 PCR test |
— |
— |
$53 |
$51 | |
| CPAP titration study |
$620 |
$620 |
$258 |
$69 | |
| Craniotomy (brain surgery) |
— |
— |
$2,675 |
$2,161 | |
| Creatine kinase (CK) test |
— |
— |
$8 |
$7 | |
| CT angiography of the chest |
$6,204 |
$6,204 |
$2,773 |
$281 | |
| CT angiography of the head |
$6,204 |
$6,204 |
$2,773 |
$274 | |
| CT scan of the abdomen |
$4,571 |
$4,571 |
$2,020 |
$230 | |
| CT scan of the abdomen and pelvis |
$7,710 |
$7,710 |
$3,603 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$7,653 |
$7,653 |
$3,421 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$9,586 |
$9,586 |
$4,285 |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$7,710 |
$7,710 |
$3,446 |
$183 | |
| CT scan of the abdomen with and without contrast |
$5,578 |
$5,578 |
$2,494 |
$259 | |
| CT scan of the abdomen with contrast |
$4,571 |
$4,571 |
$2,043 |
$230 | |
| CT scan of the abdomen without contrast |
$3,824 |
$3,824 |
$1,709 |
$136 | |
| CT scan of the arm |
$4,067 |
$4,067 |
$1,724 |
$199 | |
| CT scan of the arm with contrast |
$4,571 |
$4,571 |
$2,043 |
$199 | |
| CT scan of the arm without contrast |
$3,563 |
$3,563 |
$1,593 |
$161 | |
| CT scan of the chest |
$4,571 |
$4,571 |
$2,020 |
$167 | |
| CT scan of the chest with and without contrast |
$5,578 |
$5,578 |
$2,494 |
$196 | |
| CT scan of the chest with contrast |
$4,571 |
$4,571 |
$2,043 |
$167 | |
| CT scan of the chest without contrast |
$3,824 |
$3,824 |
$1,709 |
$133 | |
| CT scan of the head |
$4,273 |
$4,273 |
$2,048 |
$148 | |
| CT scan of the head with and without contrast |
$5,732 |
$5,732 |
$2,562 |
$173 | |
| CT scan of the head with contrast |
$4,273 |
$4,273 |
$1,910 |
$148 | |
| CT scan of the head without contrast |
$3,960 |
$3,960 |
$1,770 |
$107 | |
| CT scan of the leg |
$4,319 |
$4,319 |
$1,785 |
$166 | |
| CT scan of the leg with contrast |
$4,573 |
$4,573 |
$2,060 |
$166 | |
| CT scan of the leg without contrast |
$3,563 |
$3,563 |
$1,593 |
$130 | |
| CT scan of the lower back (lumbar spine) |
$4,813 |
$4,813 |
$2,081 |
$169 | |
| CT scan of the lower back (lumbar spine) with contrast |
$5,802 |
$5,802 |
$2,594 |
$169 | |
| CT scan of the lower back (lumbar spine) without contrast |
$3,824 |
$3,824 |
$1,709 |
$130 | |
| CT scan of the neck |
$4,571 |
$4,571 |
$2,020 |
$183 | |
| CT scan of the neck (cervical spine) |
$5,024 |
$5,024 |
$2,108 |
$168 | |
| CT scan of the neck (cervical spine) with contrast |
$5,781 |
$5,781 |
$2,584 |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$4,268 |
$4,268 |
$1,908 |
$131 | |
| CT scan of the neck with and without contrast |
$5,578 |
$5,578 |
$2,494 |
$220 | |
| CT scan of the neck with contrast |
$4,571 |
$4,571 |
$2,043 |
$183 | |
| CT scan of the neck without contrast |
$3,824 |
$3,824 |
$1,709 |
$150 | |
| CT scan of the pelvis |
$4,946 |
$4,946 |
$2,055 |
$226 | |
| CT scan of the pelvis with and without contrast |
$5,140 |
$5,140 |
$2,298 |
$251 | |
| CT scan of the pelvis with contrast |
$4,946 |
$4,946 |
$2,211 |
$226 | |
| CT scan of the pelvis without contrast |
$3,824 |
$3,824 |
$1,709 |
$133 | |
| CT scan of the sinuses |
$4,272 |
$4,272 |
$1,879 |
$152 | |
| CT scan of the sinuses with contrast |
$4,585 |
$4,585 |
$2,050 |
$152 | |
| CT scan of the sinuses without contrast |
$3,960 |
$3,960 |
$1,770 |
$128 | |
| D-dimer test |
— |
— |
$12 |
$10 | |
| Defibrillator (ICD) implant |
— |
— |
$4,043 |
$798 | |
| DHEA-sulfate test |
— |
— |
$29 |
$22 | |
| Diagnostic mammogram |
$435 |
$435 |
$104 |
$140 | |
| Dialysis fistula creation |
— |
— |
$2,675 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$2,675 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$2,675 |
$745 | |
| Drug screen (urine) |
— |
— |
$19 |
$17 | |
| Ear tubes (myringotomy) |
— |
— |
$2,675 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$5,198 |
$799 | |
| Echocardiogram |
$2,219 |
$2,219 |
$989 |
$138 | |
| Echocardiogram without contrast |
$1,648 |
$1,648 |
$737 |
$138 | |
| EKG / ECG (tracing only) |
$351 |
$351 |
$146 |
$7 | |
| Elbow replacement |
— |
— |
$14,500 |
$1,301 | |
| Electrocardiogram (EKG) |
$351 |
$351 |
$146 |
$8 | |
| Electrolyte panel |
— |
— |
$9 |
$7 | |
| Emergency department visit |
$1,499 |
$1,499 |
$675 |
$69 | |
| Emergency department visit (level 1) |
$292 |
$292 |
$131 |
$11 | |
| Emergency department visit (level 2) |
$674 |
$674 |
$303 |
$40 | |
| Emergency department visit (level 3) |
$1,499 |
$1,499 |
$675 |
$69 | |
| Emergency department visit (level 4) |
$2,493 |
$2,493 |
$1,122 |
$118 | |
| Emergency department visit (level 5) |
$4,065 |
$4,065 |
$1,829 |
$171 | |
| Endometrial biopsy |
— |
— |
$2,675 |
$98 | |
| Epidural steroid injection |
— |
— |
$2,675 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$5,198 |
$311 | |
| Esophageal dilation |
— |
— |
$2,675 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,675 |
$126 | |
| Estradiol (estrogen) test |
— |
— |
$31 |
$28 | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$2,675 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$2,675 |
$99 | |
| Fallopian tube X-ray (HSG) |
— |
— |
$5,198 |
$164 | |
| Fecal occult blood (stool) test |
$62 |
$62 |
$24 |
$10 | |
| Fecal occult blood (stool) test (guaiac, gFOBT) |
$44 |
$44 |
$15 |
$4 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
$62 |
$62 |
$27 |
$16 | |
| Feeding tube (PEG) placement |
— |
— |
$2,675 |
$178 | |
| Femoral hernia repair |
— |
— |
$5,198 |
$584 | |
| Ferritin (iron) test |
— |
— |
$18 |
$14 | |
| Fibrinogen test |
— |
— |
$11 |
$10 | |
| Fibroid removal (myomectomy) |
— |
— |
$2,675 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$2,675 |
$323 | |
| Flu test |
$44 |
$44 |
$20 |
$17 | |
| Flu vaccine |
$174 |
$174 |
$65 |
— | |
| Folate (folic acid) test |
— |
— |
$19 |
$15 | |
| Foreign body removal (skin) |
— |
— |
$2,675 |
$157 | |
| Free T4 thyroid test |
— |
— |
$12 |
$9 | |
| FSH hormone test |
— |
— |
$24 |
$19 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$5,198 |
$658 | |
| Ganglion cyst removal |
— |
— |
$2,675 |
$321 | |
| GGT liver test |
— |
— |
$9 |
$7 | |
| Glaucoma surgery |
— |
— |
$2,675 |
$984 | |
| Glucose tolerance test |
— |
— |
$11 |
$8 | |
| H. pylori test |
— |
— |
$87 |
$67 | |
| Hammertoe repair |
— |
— |
$5,198 |
$548 | |
| HDL cholesterol test |
— |
— |
$11 |
$8 | |
| Hematocrit test |
— |
— |
$3 |
$2 | |
| Hemoglobin A1c (diabetes test) |
$40 |
$40 |
$18 |
$10 | |
| Hemorrhoid removal |
— |
— |
$2,675 |
$338 | |
| Hepatitis A vaccine |
$730 |
$730 |
$328 |
— | |
| Hepatitis B test |
— |
— |
$12 |
$10 | |
| Hepatitis B vaccine |
$588 |
$588 |
$267 |
— | |
| Hepatitis C test |
— |
— |
$19 |
$14 | |
| Hip arthroscopy |
— |
— |
$5,198 |
$931 | |
| Hip fracture repair |
— |
— |
$2,675 |
$1,120 | |
| Hip replacement |
— |
— |
$14,000 |
$1,162 | |
| HIV test |
— |
— |
$23 |
$19 | |
| HIV test (antibody) |
— |
— |
$15 |
$14 | |
| HIV test (antigen/antibody combo) |
— |
— |
$31 |
$24 | |
| Holter heart monitor |
$414 |
$414 |
$172 |
$26 | |
| HPV vaccine |
$2,408 |
$2,408 |
$1,084 |
— | |
| Hydrocele repair |
— |
— |
$2,675 |
$315 | |
| Hysterectomy |
— |
— |
$4,950 |
$933 | |
| Hysteroscopy |
— |
— |
$5,198 |
$1,270 | |
| Ileostomy |
— |
— |
$2,675 |
$968 | |
| Inguinal hernia repair |
— |
— |
$5,198 |
$538 | |
| Iron blood test |
— |
— |
$8 |
$6 | |
| IUD insertion |
— |
— |
$5,198 |
— | |
| IUD removal |
— |
— |
$5,198 |
$112 | |
| IV infusion therapy |
$189 |
$189 |
$101 |
$44 | |
| IV infusion therapy (each additional) |
$78 |
$78 |
$44 |
$21 | |
| IV infusion therapy (initial) |
$495 |
$495 |
$225 |
$67 | |
| IVC filter placement |
— |
— |
$2,675 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$2,675 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
— |
— |
$2,675 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$2,675 |
$56 | |
| Kidney biopsy |
— |
— |
$2,675 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$3,875 |
$1,164 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$4,673 |
$760 | |
| Kidney ultrasound |
$1,293 |
$1,293 |
$571 |
$84 | |
| Kidney ultrasound (limited) |
$1,203 |
$1,203 |
$538 |
$61 | |
| Knee arthroscopy |
— |
— |
$5,198 |
$524 | |
| Knee joint injection |
— |
— |
$2,675 |
$69 | |
| Knee replacement |
— |
— |
$1,592 |
$18,054 | |
| Lactate test |
$87 |
$87 |
$39 |
$12 | |
| Laminectomy (spine) |
— |
— |
$5,198 |
$1,157 | |
| Laryngoscopy |
— |
— |
$2,675 |
$189 | |
| LDH test |
— |
— |
$8 |
$6 | |
| LDL cholesterol test |
— |
— |
$12 |
$11 | |
| Leg vein ultrasound (Doppler) |
$1,063 |
$1,063 |
$587 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$1,063 |
$1,063 |
$443 |
$116 | |
| LH hormone test |
— |
— |
$24 |
$19 | |
| Lipase test |
— |
— |
$9 |
$7 | |
| Lipid (cholesterol) panel |
— |
— |
$17 |
$13 | |
| Liver biopsy |
— |
— |
$2,675 |
$288 | |
| Liver function panel |
— |
— |
$10 |
$8 | |
| Lumbar discectomy |
— |
— |
$5,198 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$5,198 |
$750 | |
| Lung function test (PFT) |
$689 |
$689 |
$316 |
$37 | |
| Magnesium blood test |
— |
— |
$9 |
$7 | |
| Mastectomy |
— |
— |
$5,198 |
$1,021 | |
| Mastoidectomy |
— |
— |
$2,675 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$5,198 |
$714 | |
| MMR vaccine |
$772 |
$772 |
$347 |
— | |
| Mohs skin cancer surgery |
— |
— |
$2,675 |
$535 | |
| MRA of the brain |
$5,432 |
$5,432 |
$2,428 |
$226 | |
| MRA of the neck |
$5,977 |
$5,977 |
$2,692 |
$245 | |
| MRA of the neck with contrast |
$5,977 |
$5,977 |
$2,672 |
$245 | |
| MRA of the neck without contrast |
$7,542 |
$7,542 |
$3,371 |
$343 | |
| MRI of the abdomen |
$7,337 |
$7,337 |
$3,077 |
$300 | |
| MRI of the abdomen without contrast |
$6,221 |
$6,221 |
$2,781 |
$194 | |
| MRI of the ankle |
$6,251 |
$6,251 |
$2,735 |
$261 | |
| MRI of the ankle without contrast |
$5,763 |
$5,763 |
$2,576 |
$222 | |
| MRI of the brain |
$6,239 |
$6,239 |
$2,923 |
$269 | |
| MRI of the brain with contrast |
$6,239 |
$6,239 |
$2,789 |
$269 | |
| MRI of the brain without contrast |
$5,781 |
$5,781 |
$2,584 |
$195 | |
| MRI of the chest |
$7,224 |
$7,224 |
$3,229 |
$371 | |
| MRI of the chest without contrast |
$7,224 |
$7,224 |
$3,229 |
$466 | |
| MRI of the knee |
$6,997 |
$6,997 |
$2,928 |
$315 | |
| MRI of the knee without contrast |
$5,848 |
$5,848 |
$2,614 |
$204 | |
| MRI of the lower back (lumbar spine) |
$6,283 |
$6,283 |
$2,996 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$6,283 |
$6,283 |
$2,809 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$5,913 |
$5,913 |
$2,643 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$6,989 |
$6,989 |
$2,930 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$8,066 |
$8,066 |
$3,605 |
$319 | |
| MRI of the mid-back (thoracic spine) without contrast |
$5,913 |
$5,913 |
$2,643 |
$190 | |
| MRI of the neck (cervical spine) |
$6,283 |
$6,283 |
$2,809 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$7,106 |
$7,106 |
$3,176 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$6,283 |
$6,283 |
$2,809 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$5,913 |
$5,913 |
$2,643 |
$191 | |
| MRI of the pelvis |
$6,865 |
$6,865 |
$3,001 |
$268 | |
| MRI of the pelvis without contrast |
$5,364 |
$5,364 |
$2,398 |
$227 | |
| MRI of the shoulder |
$6,333 |
$6,333 |
$2,682 |
$313 | |
| MRI of the shoulder without contrast |
$5,497 |
$5,497 |
$2,457 |
$205 | |
| MRI of the wrist |
$5,739 |
$5,739 |
$2,628 |
$330 | |
| MRI of the wrist without contrast |
$5,915 |
$5,915 |
$2,733 |
$303 | |
| Nebulizer breathing treatment |
$620 |
$620 |
$222 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$5,198 |
$1,410 | |
| Nuchal translucency ultrasound |
$367 |
$367 |
$164 |
$116 | |
| Nuclear cardiac stress test |
$8,583 |
$8,583 |
$3,837 |
$428 | |
| Occupational therapy evaluation |
$306 |
$306 |
$137 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$306 |
$306 |
$137 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$306 |
$306 |
$137 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$306 |
$306 |
$137 |
$101 | |
| Office visit (established patient) |
$436 |
$436 |
$199 |
$115 | |
| Office visit (new patient) |
$523 |
$523 |
$218 |
$177 | |
| Office visit, established patient (level 3) |
$436 |
$436 |
$182 |
$95 | |
| Office visit, established patient (level 4) |
$523 |
$523 |
$218 |
$136 | |
| Office visit, new patient (level 4) |
$523 |
$523 |
$218 |
$177 | |
| Orthopedic hardware removal |
— |
— |
$2,675 |
$632 | |
| Ovarian cyst removal |
— |
— |
$2,675 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$2,675 |
$822 | |
| Pacemaker insertion |
— |
— |
$1,592 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$30 |
$20 | |
| Parathyroid hormone (PTH) test |
— |
— |
$53 |
$41 | |
| Parathyroid removal |
— |
— |
$2,675 |
$891 | |
| Pelvic ultrasound |
$1,147 |
$1,147 |
$538 |
$78 | |
| Pelvic ultrasound (complete) |
$1,552 |
$1,552 |
$694 |
$105 | |
| Pelvic ultrasound (limited) |
$742 |
$742 |
$331 |
$51 | |
| Phosphorus blood test |
— |
— |
$6 |
$5 | |
| Physical therapy evaluation |
$306 |
$306 |
$137 |
$98 | |
| Physical therapy evaluation (high complexity) |
$306 |
$306 |
$137 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$306 |
$306 |
$137 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$2,675 |
$541 | |
| Platelet count |
— |
— |
$6 |
$4 | |
| Pneumonia vaccine |
$606 |
$606 |
$242 |
— | |
| Pregnancy blood test (hCG) |
— |
— |
$10 |
$8 | |
| Pregnancy ultrasound |
$611 |
$611 |
$273 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$611 |
$611 |
$273 |
$117 | |
| Procalcitonin test |
— |
— |
$26 |
$27 | |
| Prolactin test |
— |
— |
$25 |
$19 | |
| Prostate removal (prostatectomy) |
— |
— |
$2,675 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$5,198 |
$526 | |
| Prostate test (PSA) |
— |
— |
$24 |
$18 | |
| Pterygium removal (eye) |
— |
— |
$2,675 |
$540 | |
| Radiofrequency nerve ablation |
— |
— |
$2,675 |
$462 | |
| Retinal detachment repair |
— |
— |
$5,198 |
$966 | |
| Rheumatoid factor test |
— |
— |
$7 |
$6 | |
| Rotator cuff repair |
— |
— |
$5,198 |
$792 | |
| Sacroiliac joint injection |
— |
— |
$2,675 |
$176 | |
| Scoliosis spine X-ray |
$863 |
$863 |
$386 |
$58 | |
| Scoliosis spine X-ray (1 view) |
$863 |
$863 |
$386 |
$44 | |
| Screening mammogram |
$474 |
$474 |
$168 |
$126 | |
| Scrotal ultrasound |
$1,254 |
$1,254 |
$561 |
$99 | |
| Sedimentation rate (ESR) test |
— |
— |
$4 |
$3 | |
| Semen analysis |
— |
— |
$16 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$5,198 |
$613 | |
| Sex hormone binding globulin test |
— |
— |
$28 |
$22 | |
| Shingles vaccine |
$1,605 |
$1,605 |
$722 |
— | |
| Shoulder arthroscopy |
— |
— |
$5,198 |
$962 | |
| Shoulder replacement |
— |
— |
$14,000 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$2,675 |
$114 | |
| Simple wound stitches |
— |
— |
$2,675 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$5,198 |
$224 | |
| Skin biopsy |
— |
— |
$2,675 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$2,675 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$2,675 |
$240 | |
| Skin graft |
— |
— |
$2,675 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$2,675 |
$36 | |
| Skin tag removal |
— |
— |
$2,675 |
$92 | |
| Sleep study (polysomnography) |
$4,931 |
$4,931 |
$2,073 |
$691 | |
| Small bowel resection |
— |
— |
$2,675 |
$1,136 | |
| Soft tissue ultrasound |
$285 |
$285 |
$128 |
$64 | |
| Speech therapy |
$210 |
$210 |
$88 |
$76 | |
| Spinal cord stimulator |
— |
— |
$5,198 |
$2,388 | |
| Spinal tap (lumbar puncture) |
— |
— |
$2,675 |
$165 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$5,198 |
$5,803 | |
| Spirometry (lung function test) |
$471 |
$471 |
$196 |
$30 | |
| Spirometry with bronchodilator |
$907 |
$907 |
$378 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$3,875 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$2,675 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$2,675 |
$475 | |
| Strep throat test |
$44 |
$44 |
$20 |
$17 | |
| Stress echocardiogram |
$3,023 |
$3,023 |
$1,330 |
$209 | |
| Stress echocardiogram (complete) |
$3,023 |
$3,023 |
$1,330 |
$233 | |
| Swallow study |
$410 |
$410 |
$173 |
$85 | |
| T3 thyroid test |
— |
— |
$18 |
$14 | |
| Tdap (tetanus) vaccine |
$413 |
$413 |
$194 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$2,675 |
$306 | |
| Testosterone test |
— |
— |
$33 |
$26 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$2,675 |
$1,004 | |
| Thyroid test (TSH) |
— |
— |
$21 |
$17 | |
| Thyroid ultrasound |
$1,244 |
$1,244 |
$556 |
$109 | |
| Tonsillectomy |
— |
— |
$2,675 |
$252 | |
| Total IgE allergy test |
— |
— |
$21 |
$16 | |
| Total protein test |
— |
— |
$5 |
$4 | |
| Tracheostomy |
— |
— |
$2,675 |
$273 | |
| Transvaginal ultrasound |
$1,210 |
$1,210 |
$541 |
$118 | |
| Trigger finger release |
— |
— |
$2,675 |
$630 | |
| Trigger point injection |
— |
— |
$2,675 |
$56 | |
| Trigger point injection (1-2 muscles) |
— |
— |
$2,675 |
$52 | |
| Triglycerides test |
— |
— |
$7 |
$6 | |
| Troponin (heart) test |
— |
— |
$13 |
$12 | |
| Tubal ligation |
— |
— |
$5,198 |
$333 | |
| Turbinate reduction |
— |
— |
$5,198 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$2,675 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$2,675 |
$575 | |
| Upper GI endoscopy (EGD) |
— |
— |
$2,675 |
$371 | |
| Upper GI series (barium) |
$1,182 |
$1,182 |
$533 |
$128 | |
| Ureteral stent placement |
— |
— |
$5,198 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$4,673 |
$365 | |
| Uric acid (gout) test |
— |
— |
$6 |
$5 | |
| Urinalysis |
$9 |
$9 |
$4 |
$3 | |
| Urine microalbumin test |
— |
— |
$7 |
$5 | |
| Urine pregnancy test |
$120 |
$120 |
$21 |
$9 | |
| Vaccine administration |
$160 |
$160 |
$56 |
$19 | |
| Vaccine administration (each additional) |
$129 |
$129 |
$53 |
$16 | |
| Vaginal delivery |
— |
— |
$1,592 |
$5,487 | |
| Varicocele repair |
— |
— |
$2,675 |
$327 | |
| Varicose vein ablation |
— |
— |
$2,675 |
$1,018 | |
| Vasectomy |
— |
— |
$2,675 |
$347 | |
| Vitamin B12 test |
— |
— |
$20 |
$15 | |
| Vitamin D test |
— |
— |
$38 |
$30 | |
| Vitrectomy (eye) |
— |
— |
$5,198 |
$814 | |
| Vocal cord injection |
— |
— |
$2,675 |
$211 | |
| Wart removal |
— |
— |
$2,675 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$1,592 |
$11,645 | |
| Whipple procedure (pancreas) |
— |
— |
$2,675 |
$2,871 | |
| Wound debridement |
— |
— |
$2,675 |
$186 | |
| Wrist fracture repair |
— |
— |
$5,198 |
$735 | |
| X-ray of the abdomen |
$477 |
$477 |
$205 |
$36 | |
| X-ray of the ankle |
$530 |
$530 |
$237 |
$37 | |
| X-ray of the collarbone |
$435 |
$435 |
$194 |
$33 | |
| X-ray of the elbow |
$595 |
$595 |
$266 |
$33 | |
| X-ray of the facial bones |
$704 |
$704 |
$330 |
$39 | |
| X-ray of the foot |
$530 |
$530 |
$237 |
$34 | |
| X-ray of the forearm |
$435 |
$435 |
$194 |
$29 | |
| X-ray of the hand |
$530 |
$530 |
$237 |
$38 | |
| X-ray of the hip |
$1,110 |
$1,110 |
$496 |
$49 | |
| X-ray of the hip (1 view) |
$1,110 |
$1,110 |
$496 |
$34 | |
| X-ray of the hip (3 views) |
$1,110 |
$1,110 |
$496 |
$49 | |
| X-ray of the knee |
$583 |
$583 |
$258 |
$42 | |
| X-ray of the knee (2 views) |
$477 |
$477 |
$213 |
$34 | |
| X-ray of the knee (3 views) |
$583 |
$583 |
$261 |
$42 | |
| X-ray of the knee (4+ views) |
$698 |
$698 |
$312 |
$49 | |
| X-ray of the lower back (lumbar spine) |
$661 |
$661 |
$293 |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$479 |
$479 |
$214 |
$40 | |
| X-ray of the lower back (lumbar spine) (4+ views) |
$842 |
$842 |
$376 |
$53 | |
| X-ray of the lower leg |
$416 |
$416 |
$186 |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$656 |
$656 |
$291 |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$479 |
$479 |
$214 |
$33 | |
| X-ray of the mid-back (thoracic spine) (3 views) |
$833 |
$833 |
$372 |
$39 | |
| X-ray of the neck (cervical spine) |
$1,067 |
$1,067 |
$466 |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$983 |
$983 |
$439 |
$40 | |
| X-ray of the pelvis |
$698 |
$698 |
$309 |
$36 | |
| X-ray of the pelvis (1 view) |
$652 |
$652 |
$291 |
$28 | |
| X-ray of the ribs |
$821 |
$821 |
$317 |
$42 | |
| X-ray of the ribs (2 views) |
$631 |
$631 |
$282 |
$36 | |
| X-ray of the ribs (3 views) |
$838 |
$838 |
$375 |
$42 | |
| X-ray of the shoulder |
$511 |
$511 |
$228 |
$36 | |
| X-ray of the skull |
$712 |
$712 |
$333 |
$40 | |
| X-ray of the upper arm |
$416 |
$416 |
$186 |
$32 | |
| X-ray of the wrist |
$634 |
$634 |
$283 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$2,675 |
$335 | |
| Zinc blood test |
— |
— |
$15 |
$11 | |