| 3D mammogram (tomosynthesis) |
— |
— |
$54 |
$51 | |
| Abdominal fluid drain (paracentesis) |
— |
— |
$1,650 |
$284 | |
| Abdominal ultrasound |
$4,682 |
$4,682 |
$339 |
$100 | |
| Abdominal ultrasound (limited) |
$4,682 |
$4,682 |
$839 |
$86 | |
| Abscess drainage (complex or multiple) |
— |
— |
$1,096 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$307 |
$129 | |
| Abscess incision and drainage |
— |
— |
$716 |
$174 | |
| Achilles tendon repair |
— |
— |
$12,103 |
$624 | |
| ACL knee reconstruction |
— |
— |
$8,778 |
$889 | |
| Acupuncture |
— |
— |
$191 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$176 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$5,501 |
$204 | |
| Albumin blood test |
$297 |
$297 |
$18 |
$5 | |
| Allergy patch testing |
— |
— |
$6,181 |
$5 | |
| Allergy shots |
— |
— |
$259 |
$11 | |
| Allergy testing |
— |
— |
$6,181 |
$4 | |
| Amniocentesis |
— |
— |
$623 |
$120 | |
| Anal fistula repair |
— |
— |
$4,923 |
$541 | |
| Ankle fracture repair |
— |
— |
$12,361 |
$608 | |
| Ankle replacement |
— |
— |
$23,645 |
$885 | |
| Annual physical (established patient) |
— |
— |
$637 |
— | |
| Annual physical (new patient) |
— |
— |
$695 |
— | |
| Anoscopy |
— |
— |
$317 |
$129 | |
| Antinuclear antibody (ANA) test |
$145 |
$145 |
$15 |
$12 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$16,163 |
$1,345 | |
| Aortic valve replacement |
$111,098 |
$111,098 |
$17,799 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$30,189 |
$592 | |
| Arterial blood gas (ABG) |
$427 |
$427 |
$104 |
$26 | |
| Barium swallow study |
$2,711 |
$2,711 |
$288 |
$107 | |
| Bartholin cyst removal |
— |
— |
$796 |
$182 | |
| Benign skin lesion removal |
— |
— |
$1,153 |
$171 | |
| Bladder function test (urodynamics) |
— |
— |
$307 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$1,169 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$6,094 |
$236 | |
| Blood clotting test (PT/INR) |
$311 |
$311 |
$18 |
$4 | |
| Blood crossmatch |
— |
— |
$141 |
— | |
| Blood transfusion |
$2,635 |
$2,635 |
$948 |
$47 | |
| Blood type test |
$546 |
$546 |
$12 |
$3 | |
| Blood type test (ABO group) |
$546 |
$546 |
$12 |
$3 | |
| BNP (heart failure) test |
$520 |
$520 |
$157 |
$39 | |
| Bone density scan (DEXA) |
$1,934 |
$1,934 |
$116 |
$39 | |
| Bone marrow biopsy |
$7,822 |
$7,822 |
$1,991 |
$172 | |
| Bone scan (nuclear) |
$8,040 |
$8,040 |
$294 |
$259 | |
| Botox for migraine |
— |
— |
$307 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$13,688 |
$1,023 | |
| Breast biopsy |
$23,038 |
$23,038 |
$2,882 |
$478 | |
| Breast MRI |
— |
— |
$2,455 |
$216 | |
| Breast MRI without contrast |
— |
— |
$2,455 |
$216 | |
| Breast reconstruction |
— |
— |
$17,114 |
$1,227 | |
| Breast reduction |
— |
— |
$10,998 |
$980 | |
| Breast ultrasound |
$2,352 |
$2,352 |
$740 |
$92 | |
| Breast ultrasound (complete) |
$2,687 |
$2,687 |
$1,209 |
$100 | |
| Breast ultrasound (limited) |
$1,345 |
$1,345 |
$605 |
$84 | |
| Breathing tube insertion (intubation) |
— |
— |
$428 |
$133 | |
| Bronchoscopy |
— |
— |
$2,989 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$6,871 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$367 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$367 |
$93 | |
| Burn treatment |
— |
— |
$367 |
$129 | |
| Capsule endoscopy |
$6,275 |
$6,275 |
$823 |
$802 | |
| Cardiac ablation |
$106,963 |
$106,963 |
$42,914 |
$759 | |
| Cardiac catheterization |
$77,714 |
$77,714 |
$21,460 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$1,397 |
$170 | |
| Cardiac MRI |
$7,102 |
$7,102 |
$399 |
$322 | |
| Cardiac MRI without contrast |
$7,102 |
$7,102 |
$518 |
$280 | |
| Cardiac rehabilitation |
$454 |
$454 |
$209 |
$26 | |
| Carotid artery surgery |
— |
— |
$14,783 |
$1,026 | |
| Carotid artery ultrasound |
$2,617 |
$2,617 |
$621 |
$156 | |
| Carpal tunnel release |
— |
— |
$3,611 |
$483 | |
| Cataract surgery |
— |
— |
$4,246 |
$547 | |
| Central line placement |
$9,547 |
$9,547 |
$2,583 |
$238 | |
| Cervical cerclage |
— |
— |
$5,246 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$4,297 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$5,736 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$726 |
$131 | |
| Chemotherapy infusion |
$1,488 |
$1,488 |
$567 |
$81 | |
| Chemotherapy infusion (each additional) |
$792 |
$792 |
$433 |
$28 | |
| Chemotherapy infusion (first hour) |
$2,346 |
$2,346 |
$1,290 |
$133 | |
| Chest tube insertion |
$12,521 |
$12,521 |
$3,425 |
$143 | |
| Chest X-ray |
$1,836 |
$1,836 |
$119 |
$37 | |
| Chest X-ray (1 view) |
$1,164 |
$1,164 |
$70 |
$25 | |
| Chest X-ray (2 views) |
$1,230 |
$1,230 |
$94 |
$33 | |
| Chickenpox (varicella) vaccine |
— |
— |
$380 |
— | |
| Chiropractic adjustment |
— |
— |
$167 |
$38 | |
| Circumcision |
— |
— |
$3,720 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$16,235 |
$1,238 | |
| Colonoscopy |
— |
— |
$2,109 |
$480 | |
| Colostomy |
— |
— |
$15,712 |
$1,122 | |
| Colposcopy |
— |
— |
$733 |
$161 | |
| Complete blood count (CBC) (complete) |
— |
— |
$8 |
$8 | |
| Complex wound repair |
— |
— |
$1,044 |
$390 | |
| Comprehensive eye exam |
— |
— |
$788 |
$138 | |
| Contact lens fitting |
— |
— |
$414 |
— | |
| Continuous glucose monitor setup |
— |
— |
$248 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$289 |
$115 | |
| Corneal transplant |
— |
— |
$8,018 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$61,886 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$50,920 |
$36,593 | |
| Coronary CT angiography |
$9,473 |
$9,473 |
$206 |
$326 | |
| Cortisol test |
$242 |
$242 |
$65 |
$16 | |
| COVID-19 PCR test |
$56 |
$56 |
$51 |
$51 | |
| CPAP titration study |
$1,418 |
$1,418 |
$805 |
$69 | |
| Craniotomy (brain surgery) |
— |
— |
$22,206 |
$2,161 | |
| CT angiography of the chest |
$11,817 |
$11,817 |
$1,212 |
$281 | |
| CT angiography of the head |
$12,267 |
$12,267 |
$1,212 |
$274 | |
| CT colonography (virtual colonoscopy) |
$2,723 |
$2,723 |
$1,487 |
$835 | |
| CT scan of the abdomen and pelvis |
$24,004 |
$24,004 |
$1,206 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$25,970 |
$25,970 |
$1,212 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$24,004 |
$24,004 |
$1,212 |
$300 | |
| CT scan of the abdomen with and without contrast |
$17,313 |
$17,313 |
$1,212 |
$259 | |
| CT scan of the arm |
$9,926 |
$9,926 |
$3,368 |
$199 | |
| CT scan of the arm with contrast |
$9,926 |
$9,926 |
$2,730 |
$199 | |
| CT scan of the arm without contrast |
$7,721 |
$7,721 |
$2,603 |
$161 | |
| CT scan of the chest |
$12,395 |
$12,395 |
$1,429 |
$167 | |
| CT scan of the chest with contrast |
$12,395 |
$12,395 |
$1,429 |
$167 | |
| CT scan of the chest without contrast |
$11,652 |
$11,652 |
$1,429 |
$133 | |
| CT scan of the head |
$12,474 |
$12,474 |
$1,425 |
$148 | |
| CT scan of the head with and without contrast |
$13,087 |
$13,087 |
$1,212 |
$173 | |
| CT scan of the head with contrast |
$12,474 |
$12,474 |
$1,429 |
$148 | |
| CT scan of the head without contrast |
$10,145 |
$10,145 |
$1,429 |
$107 | |
| CT scan of the leg |
$11,259 |
$11,259 |
$5,067 |
$166 | |
| CT scan of the leg with contrast |
$11,713 |
$11,713 |
$5,315 |
$166 | |
| CT scan of the leg without contrast |
$9,664 |
$9,664 |
$4,832 |
$130 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
$17,043 |
$17,043 |
$1,212 |
$197 | |
| CT scan of the neck |
$11,659 |
$11,659 |
$880 |
$183 | |
| CT scan of the neck with and without contrast |
$12,876 |
$12,876 |
$773 |
$220 | |
| CT scan of the neck with contrast |
$11,659 |
$11,659 |
$1,212 |
$183 | |
| CT scan of the neck without contrast |
$11,459 |
$11,459 |
$688 |
$150 | |
| CT scan of the pelvis |
$13,409 |
$13,409 |
$1,429 |
$226 | |
| CT scan of the pelvis with and without contrast |
$15,029 |
$15,029 |
$1,212 |
$251 | |
| CT scan of the pelvis with contrast |
$13,946 |
$13,946 |
$1,506 |
$226 | |
| CT scan of the sinuses |
$10,565 |
$10,565 |
$708 |
$152 | |
| CT scan of the sinuses with and without contrast |
$12,194 |
$12,194 |
$732 |
$184 | |
| CT scan of the sinuses with contrast |
$10,565 |
$10,565 |
$708 |
$152 | |
| CT scan of the sinuses without contrast |
$9,852 |
$9,852 |
$591 |
$128 | |
| Defibrillator (ICD) implant |
$122,729 |
$122,729 |
$26,223 |
$798 | |
| Developmental screening (child) |
$789 |
$789 |
$395 |
— | |
| Diagnostic mammogram |
$1,377 |
$1,377 |
$382 |
$140 | |
| Dialysis fistula creation |
— |
— |
$4,767 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$5,246 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$4,064 |
$745 | |
| Drug screen (urine) |
$309 |
$309 |
$53 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$227 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$1,672 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$10,186 |
$799 | |
| Echocardiogram with and without contrast |
$4,828 |
$4,828 |
$946 |
$101 | |
| EKG / ECG (tracing only) |
$1,468 |
$1,468 |
$288 |
$7 | |
| Elbow replacement |
— |
— |
$14,000 |
$1,301 | |
| Electrocardiogram (EKG) |
$1,468 |
$1,468 |
$282 |
$8 | |
| Electroencephalogram (EEG) |
$6,204 |
$6,204 |
$2,610 |
$448 | |
| Emergency department visit |
$4,587 |
$4,587 |
$1,633 |
$69 | |
| Emergency department visit (level 2) |
$3,266 |
$3,266 |
$1,179 |
$40 | |
| Emergency department visit (level 3) |
$4,587 |
$4,587 |
$2,064 |
$69 | |
| Emergency department visit (level 4) |
$7,192 |
$7,192 |
$3,308 |
$118 | |
| Emergency department visit (level 5) |
$11,914 |
$11,914 |
$5,362 |
$171 | |
| Endometrial biopsy |
— |
— |
$307 |
$98 | |
| ERCP (bile duct endoscopy) |
— |
— |
$6,094 |
$311 | |
| Esophageal dilation |
— |
— |
$2,287 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,989 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$135 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$2,989 |
$552 | |
| Fallopian tube X-ray (HSG) |
$2,459 |
$2,459 |
$335 |
$164 | |
| Fecal occult blood (stool) test |
$338 |
$338 |
$18 |
$10 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
$338 |
$338 |
$19 |
$16 | |
| Feeding tube (PEG) placement |
$7,273 |
$7,273 |
$2,989 |
$178 | |
| Femoral hernia repair |
— |
— |
$6,530 |
$584 | |
| Ferritin (iron) test |
$742 |
$742 |
$42 |
$14 | |
| Fibroid removal (myomectomy) |
— |
— |
$11,803 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$1,604 |
$323 | |
| Flu test |
$407 |
$407 |
$66 |
$17 | |
| Flu vaccine |
— |
— |
$33 |
— | |
| Folate (folic acid) test |
$588 |
$588 |
$18 |
$15 | |
| Foreign body removal (skin) |
— |
— |
$307 |
$157 | |
| FSH hormone test |
$614 |
$614 |
$22 |
$19 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$8,314 |
$658 | |
| Gallbladder scan (HIDA) |
$5,860 |
$5,860 |
$424 |
$334 | |
| Ganglion cyst removal |
— |
— |
$2,846 |
$321 | |
| Glaucoma surgery |
— |
— |
$1,815 |
$984 | |
| H. pylori test |
$1,246 |
$1,246 |
$136 |
$67 | |
| Hammertoe repair |
— |
— |
$5,749 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$941 |
$36 | |
| Hemoglobin A1c (diabetes test) |
$378 |
$378 |
$12 |
$10 | |
| Hemorrhoid removal |
— |
— |
$2,646 |
$338 | |
| Hepatitis A vaccine |
$762 |
$762 |
$238 |
— | |
| Hepatitis B vaccine |
$522 |
$522 |
$260 |
— | |
| Hepatitis C test |
$689 |
$689 |
$17 |
$14 | |
| Hip arthroscopy |
— |
— |
$8,778 |
$931 | |
| Hip fracture repair |
— |
— |
$16,001 |
$1,120 | |
| Hip replacement |
— |
— |
$39,104 |
$1,162 | |
| HIV test |
$377 |
$377 |
$29 |
$19 | |
| HIV test (antibody) |
$621 |
$621 |
$16 |
$14 | |
| HIV test (antigen/antibody combo) |
$377 |
$377 |
$29 |
$24 | |
| Home sleep apnea test |
— |
— |
$1,393 |
$123 | |
| HPV vaccine |
— |
— |
$651 |
— | |
| Hydrocele repair |
— |
— |
$6,530 |
$315 | |
| Hysterectomy |
— |
— |
$13,120 |
$933 | |
| Hysteroscopy |
— |
— |
$5,246 |
$1,270 | |
| Ileostomy |
— |
— |
$13,634 |
$968 | |
| Incisional hernia repair |
— |
— |
$7,842 |
— | |
| Inguinal hernia repair |
— |
— |
$6,530 |
$538 | |
| Iron blood test |
$447 |
$447 |
$8 |
$6 | |
| IUD insertion |
— |
— |
$694 |
— | |
| IUD removal |
— |
— |
$497 |
$112 | |
| IV infusion therapy |
$1,325 |
$1,325 |
$538 |
$44 | |
| IV infusion therapy (each additional) |
$854 |
$854 |
$427 |
$21 | |
| IV infusion therapy (initial) |
$1,374 |
$1,374 |
$687 |
$67 | |
| IVC filter placement |
$49,830 |
$49,830 |
$14,632 |
$1,885 | |
| Joint aspiration (small/intermediate) |
$2,297 |
$2,297 |
$396 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
$2,297 |
$2,297 |
$546 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$236 |
$56 | |
| Kidney biopsy |
$5,342 |
$5,342 |
$2,882 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$16,731 |
$1,164 | |
| Kidney scan (nuclear) |
$7,642 |
$7,642 |
$179 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$6,339 |
$760 | |
| Kidney ultrasound |
$3,432 |
$3,432 |
$301 |
$84 | |
| Kidney ultrasound (limited) |
$3,183 |
$3,183 |
$136 |
$61 | |
| Knee arthroscopy |
— |
— |
$5,749 |
$524 | |
| Knee joint injection |
$2,347 |
$2,347 |
$652 |
$69 | |
| Knee replacement |
— |
— |
$5,751 |
$18,054 | |
| Laminectomy (spine) |
— |
— |
$8,778 |
$1,157 | |
| Laryngoscopy |
— |
— |
$751 |
$189 | |
| LDL cholesterol test |
— |
— |
$11 |
$11 | |
| Leg artery angiogram |
$10,910 |
$10,910 |
$2,616 |
$149 | |
| Leg artery angioplasty |
$77,517 |
$77,517 |
$17,043 |
— | |
| Leg vein ultrasound (Doppler) |
$3,379 |
$3,379 |
$662 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$1,988 |
$1,988 |
$422 |
$116 | |
| LH hormone test |
$841 |
$841 |
$22 |
$19 | |
| Lipid (cholesterol) panel |
$768 |
$768 |
$16 |
$13 | |
| Liver biopsy |
$3,739 |
$3,739 |
$2,613 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$87,692 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$8,778 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$6,094 |
$750 | |
| Lung function test (PFT) |
$1,302 |
$1,302 |
$633 |
$37 | |
| Lung scan (V/Q) |
$11,863 |
$11,863 |
$327 |
$291 | |
| Mastectomy |
— |
— |
$10,998 |
$1,021 | |
| Mastoidectomy |
— |
— |
$6,094 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$5,749 |
$714 | |
| MMR vaccine |
$584 |
$584 |
$199 |
— | |
| Mohs skin cancer surgery |
— |
— |
$1,815 |
$535 | |
| MRA of the brain |
$11,401 |
$11,401 |
$708 |
$226 | |
| MRA of the brain with contrast |
$11,401 |
$11,401 |
$828 |
$226 | |
| MRA of the brain without contrast |
$12,709 |
$12,709 |
$828 |
$328 | |
| MRA of the neck |
$12,709 |
$12,709 |
$747 |
$245 | |
| MRA of the neck with contrast |
$12,709 |
$12,709 |
$828 |
$245 | |
| MRA of the neck without contrast |
$15,315 |
$15,315 |
$828 |
$343 | |
| MRI of the abdomen |
$14,121 |
$14,121 |
$811 |
$300 | |
| MRI of the abdomen with contrast |
$14,121 |
$14,121 |
$828 |
$300 | |
| MRI of the abdomen without contrast |
$13,217 |
$13,217 |
$518 |
$194 | |
| MRI of the ankle |
$14,624 |
$14,624 |
$1,433 |
$261 | |
| MRI of the ankle with contrast |
$14,624 |
$14,624 |
$1,433 |
$261 | |
| MRI of the ankle without contrast |
$10,834 |
$10,834 |
$1,594 |
$222 | |
| MRI of the brain |
$14,764 |
$14,764 |
$828 |
$269 | |
| MRI of the brain with contrast |
$14,764 |
$14,764 |
$828 |
$269 | |
| MRI of the brain without contrast |
$14,075 |
$14,075 |
$518 |
$195 | |
| MRI of the chest |
$12,691 |
$12,691 |
$747 |
$371 | |
| MRI of the chest with contrast |
$10,595 |
$10,595 |
$1,433 |
$371 | |
| MRI of the chest without contrast |
$14,709 |
$14,709 |
$828 |
$466 | |
| MRI of the knee |
$12,704 |
$12,704 |
$2,455 |
$315 | |
| MRI of the knee with contrast |
$12,704 |
$12,704 |
$1,609 |
$315 | |
| MRI of the knee without contrast |
$12,092 |
$12,092 |
$2,894 |
$204 | |
| MRI of the lower back (lumbar spine) |
$14,581 |
$14,581 |
$797 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$14,581 |
$14,581 |
$828 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$12,764 |
$12,764 |
$518 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$14,581 |
$14,581 |
$796 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$17,175 |
$17,175 |
$828 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$14,581 |
$14,581 |
$828 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$12,730 |
$12,730 |
$518 |
$190 | |
| MRI of the neck (cervical spine) |
$14,708 |
$14,708 |
$800 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$17,369 |
$17,369 |
$828 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$14,708 |
$14,708 |
$828 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$12,874 |
$12,874 |
$518 |
$191 | |
| MRI of the pelvis |
$14,172 |
$14,172 |
$820 |
$268 | |
| MRI of the pelvis with contrast |
$14,172 |
$14,172 |
$828 |
$268 | |
| MRI of the pelvis without contrast |
$13,529 |
$13,529 |
$518 |
$227 | |
| MRI of the shoulder |
$10,994 |
$10,994 |
$1,609 |
$313 | |
| MRI of the shoulder with contrast |
$14,624 |
$14,624 |
$1,609 |
$313 | |
| MRI of the shoulder without contrast |
$10,994 |
$10,994 |
$1,651 |
$205 | |
| MRI of the wrist |
$14,329 |
$14,329 |
$1,844 |
$330 | |
| MRI of the wrist with contrast |
$14,329 |
$14,329 |
$2,025 |
$330 | |
| MRI of the wrist without contrast |
$10,834 |
$10,834 |
$1,594 |
$303 | |
| Nebulizer breathing treatment |
$509 |
$509 |
$249 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$7,358 |
$1,410 | |
| Newborn hospital care |
— |
— |
$417 |
$58 | |
| Nuchal translucency ultrasound |
$1,425 |
$1,425 |
$249 |
$116 | |
| Nuclear cardiac stress test |
$16,870 |
$16,870 |
$2,868 |
$428 | |
| Occupational therapy evaluation |
$743 |
$743 |
$118 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$831 |
$831 |
$118 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$668 |
$668 |
$118 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$743 |
$743 |
$118 |
$101 | |
| Office visit, established patient (level 4) |
$1,994 |
$1,994 |
$732 |
$136 | |
| Office visit, new patient (level 4) |
$2,631 |
$2,631 |
$1,221 |
$177 | |
| Office visit, new patient (level 5) |
$3,214 |
$3,214 |
$1,410 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$4,870 |
$632 | |
| Ovarian cyst removal |
— |
— |
$8,970 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$10,591 |
$822 | |
| Pacemaker insertion |
— |
— |
$21,830 |
$15,506 | |
| Pap smear (cervical screening) |
$248 |
$248 |
$32 |
$20 | |
| Parathyroid hormone (PTH) test |
$1,415 |
$1,415 |
$165 |
$41 | |
| Parathyroid removal |
— |
— |
$10,186 |
$891 | |
| Pelvic ultrasound |
$4,235 |
$4,235 |
$297 |
$78 | |
| Pelvic ultrasound (limited) |
$2,459 |
$2,459 |
$109 |
$51 | |
| PET scan |
$22,225 |
$22,225 |
$1,564 |
— | |
| Physical therapy evaluation |
$780 |
$780 |
$115 |
$98 | |
| Physical therapy evaluation (high complexity) |
$867 |
$867 |
$115 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$780 |
$780 |
$115 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$1,815 |
$541 | |
| Pregnancy ultrasound |
$3,507 |
$3,507 |
$360 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$2,905 |
$2,905 |
$289 |
$117 | |
| Procalcitonin test |
$762 |
$762 |
$33 |
$27 | |
| Prolactin test |
$882 |
$882 |
$23 |
$19 | |
| Prostate biopsy |
$8,462 |
$8,462 |
$2,989 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$15,288 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$8,886 |
$526 | |
| Prostate test (PSA) |
$637 |
$637 |
$22 |
$18 | |
| Psychiatric evaluation |
$1,288 |
$1,288 |
$599 |
$188 | |
| Pterygium removal (eye) |
— |
— |
$4,064 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$135 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$3,611 |
$462 | |
| Retina scan (OCT) |
— |
— |
$374 |
$33 | |
| Retinal (fundus) photography |
$527 |
$527 |
$295 |
$37 | |
| Retinal detachment repair |
— |
— |
$8,018 |
$966 | |
| Rotator cuff repair |
— |
— |
$10,289 |
$792 | |
| Routine eye exam |
— |
— |
$788 |
$88 | |
| RSV vaccine |
— |
— |
$632 |
— | |
| Sacroiliac joint injection |
— |
— |
$1,073 |
$176 | |
| Scoliosis spine X-ray |
$2,394 |
$2,394 |
$182 |
$58 | |
| Screening colonoscopy |
— |
— |
$1,604 |
$378 | |
| Screening mammogram |
$1,350 |
$1,350 |
$152 |
$126 | |
| Scrotal ultrasound |
$4,137 |
$4,137 |
$288 |
$99 | |
| Septoplasty (deviated septum) |
— |
— |
$5,501 |
$613 | |
| Sex hormone binding globulin test |
$255 |
$255 |
$26 |
$22 | |
| Shingles vaccine |
— |
— |
$273 |
— | |
| Shoulder arthroscopy |
— |
— |
$10,289 |
$962 | |
| Shoulder replacement |
— |
— |
$46,662 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$508 |
$114 | |
| Simple wound stitches |
— |
— |
$508 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$6,094 |
$224 | |
| Skin biopsy |
$1,631 |
$1,631 |
$827 |
$121 | |
| Skin biopsy (punch) |
$1,631 |
$1,631 |
$815 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$1,619 |
$240 | |
| Skin graft |
— |
— |
$3,817 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$1,638 |
$36 | |
| Skin tag removal |
— |
— |
$508 |
$92 | |
| Sleep study (polysomnography) |
— |
— |
$1,400 |
$691 | |
| Small bowel resection |
— |
— |
$15,996 |
$1,136 | |
| Soft tissue ultrasound |
$1,705 |
$1,705 |
$40 |
$64 | |
| Speech therapy |
$771 |
$771 |
$385 |
$76 | |
| Spinal cord stimulator |
— |
— |
$12,361 |
$2,388 | |
| Spine fracture repair (kyphoplasty) |
$34,335 |
$34,335 |
$10,289 |
$5,803 | |
| Spirometry (lung function test) |
$1,055 |
$1,055 |
$590 |
$30 | |
| Spirometry with bronchodilator |
$1,548 |
$1,548 |
$748 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$15,081 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$18,976 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$4,857 |
$475 | |
| Stress echocardiogram |
$9,699 |
$9,699 |
$1,901 |
$209 | |
| Stress echocardiogram (complete) |
— |
— |
$1,017 |
$233 | |
| Swallow study |
$819 |
$819 |
$334 |
$85 | |
| T3 thyroid test |
$621 |
$621 |
$17 |
$14 | |
| Testicle removal (orchiectomy) |
— |
— |
$6,339 |
$306 | |
| Testosterone test |
$351 |
$351 |
$52 |
$26 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$12,103 |
$1,004 | |
| Thyroid ultrasound |
$3,638 |
$3,638 |
$343 |
$109 | |
| Thyroid uptake scan |
$4,550 |
$4,550 |
$223 |
$145 | |
| Tilt table test |
$10,568 |
$10,568 |
$5,812 |
$168 | |
| Tonsillectomy |
— |
— |
$5,501 |
$252 | |
| Total IgE allergy test |
$551 |
$551 |
$20 |
$16 | |
| Tracheostomy |
— |
— |
$6,094 |
$273 | |
| Transesophageal echocardiogram (TEE) |
$13,333 |
$13,333 |
$365 |
$239 | |
| Trigger finger release |
— |
— |
$2,846 |
$630 | |
| Trigger point injection |
$1,206 |
$1,206 |
$462 |
$56 | |
| Trigger point injection (1-2 muscles) |
$1,206 |
$1,206 |
$543 |
$52 | |
| Tubal ligation |
— |
— |
$9,211 |
$333 | |
| Turbinate reduction |
— |
— |
$5,501 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$6,094 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$3,611 |
$575 | |
| Umbilical hernia repair |
— |
— |
$7,842 |
— | |
| Upper GI endoscopy (EGD) |
— |
— |
$1,650 |
$371 | |
| Upper GI series (barium) |
$3,081 |
$3,081 |
$351 |
$128 | |
| Ureteral stent placement |
— |
— |
$6,094 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$8,886 |
$365 | |
| Urine microalbumin test |
$393 |
$393 |
$7 |
$5 | |
| UV light therapy (skin) |
— |
— |
$374 |
$106 | |
| Vaccine administration |
$340 |
$340 |
$178 |
$19 | |
| Vaccine administration (each additional) |
$340 |
$340 |
$184 |
$16 | |
| Vaginal delivery |
— |
— |
$5,736 |
$5,487 | |
| Varicocele repair |
— |
— |
$6,094 |
$327 | |
| Varicose vein ablation |
— |
— |
$5,820 |
$1,018 | |
| Vasectomy |
— |
— |
$3,720 |
$347 | |
| Visual field test |
— |
— |
$741 |
$64 | |
| Vitamin B12 test |
$597 |
$597 |
$18 |
$15 | |
| Vitrectomy (eye) |
— |
— |
$8,018 |
$814 | |
| Vocal cord injection |
— |
— |
$6,094 |
$211 | |
| Wart removal |
— |
— |
$508 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$17,593 |
$11,645 | |
| Well-child visit |
— |
— |
$522 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$22,206 |
$2,871 | |
| Wound debridement |
— |
— |
$930 |
$186 | |
| Wrist fracture repair |
— |
— |
$12,361 |
$735 | |
| X-ray of the abdomen |
$2,582 |
$2,582 |
$105 |
$36 | |
| X-ray of the ankle |
$2,057 |
$2,057 |
$219 |
$37 | |
| X-ray of the collarbone |
$1,820 |
$1,820 |
$204 |
$33 | |
| X-ray of the elbow |
$1,744 |
$1,744 |
$182 |
$33 | |
| X-ray of the facial bones |
$2,394 |
$2,394 |
$140 |
$39 | |
| X-ray of the foot |
$1,812 |
$1,812 |
$204 |
$34 | |
| X-ray of the forearm |
$1,796 |
$1,796 |
$187 |
$29 | |
| X-ray of the hand |
$1,966 |
$1,966 |
$210 |
$38 | |
| X-ray of the hip (4 views) |
— |
— |
$188 |
$63 | |
| X-ray of the knee |
$1,744 |
$1,744 |
$245 |
$42 | |
| X-ray of the knee (2 views) |
$1,227 |
$1,227 |
$310 |
$34 | |
| X-ray of the knee (3 views) |
$1,744 |
$1,744 |
$204 |
$42 | |
| X-ray of the knee (4+ views) |
$2,150 |
$2,150 |
$245 |
$49 | |
| X-ray of the lower leg |
$1,981 |
$1,981 |
$792 |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$2,061 |
$2,061 |
$116 |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$2,061 |
$2,061 |
$100 |
$33 | |
| X-ray of the neck (cervical spine) |
$2,232 |
$2,232 |
$160 |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$2,232 |
$2,232 |
$117 |
$40 | |
| X-ray of the pelvis |
$2,415 |
$2,415 |
$123 |
$36 | |
| X-ray of the ribs |
$2,090 |
$2,090 |
$136 |
$42 | |
| X-ray of the ribs (2 views) |
$2,090 |
$2,090 |
$148 |
$36 | |
| X-ray of the shoulder |
$2,305 |
$2,305 |
$219 |
$36 | |
| X-ray of the skull |
$2,281 |
$2,281 |
$127 |
$40 | |
| X-ray of the thigh bone |
— |
— |
$24 |
— | |
| X-ray of the upper arm |
$1,592 |
$1,592 |
$306 |
$32 | |
| X-ray of the wrist |
$2,023 |
$2,023 |
$209 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$1,065 |
$335 | |