| 3D mammogram (tomosynthesis) |
$282 |
$282 |
$101 |
$51 | |
| Abdominal fluid drain (paracentesis) |
$4,525 |
$4,525 |
$2,350 |
$284 | |
| Abdominal ultrasound |
$3,219 |
$3,219 |
$997 |
$100 | |
| Abdominal ultrasound (complete) |
$3,251 |
$3,251 |
$1,294 |
$114 | |
| Abdominal ultrasound (limited) |
$2,450 |
$2,450 |
$759 |
$86 | |
| Abscess drainage (complex or multiple) |
— |
— |
$1,454 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$1,454 |
$129 | |
| Abscess incision and drainage |
— |
— |
$1,454 |
$174 | |
| Achilles tendon repair |
— |
— |
$8,072 |
$624 | |
| ACL knee reconstruction |
— |
— |
$9,417 |
$889 | |
| Acupuncture |
— |
— |
$106 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$99 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$5,593 |
$204 | |
| Aldosterone test |
$1,363 |
$1,363 |
$44 |
$41 | |
| Allergy patch testing |
— |
— |
$3,463 |
$5 | |
| Allergy shots |
— |
— |
$145 |
$11 | |
| Allergy testing |
— |
— |
$3,463 |
$4 | |
| Ammonia blood test |
$712 |
$712 |
$16 |
$15 | |
| Amniocentesis |
— |
— |
$402 |
$120 | |
| Anal fistula repair |
— |
— |
$5,415 |
$541 | |
| Ankle fracture repair |
— |
— |
$8,580 |
$608 | |
| Ankle replacement |
— |
— |
$12,859 |
$885 | |
| Annual physical (established patient) |
— |
— |
$358 |
— | |
| Annual physical (new patient) |
— |
— |
$409 |
— | |
| Anoscopy |
— |
— |
$1,574 |
$129 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$20,013 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$16,144 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$22,756 |
$592 | |
| Barium swallow study |
$1,722 |
$1,722 |
$341 |
$107 | |
| Bartholin cyst removal |
— |
— |
$1,454 |
$182 | |
| Benign skin lesion removal |
— |
— |
$1,217 |
$171 | |
| Bladder function test (urodynamics) |
— |
— |
$1,469 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$1,586 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$4,523 |
$236 | |
| Blood transfusion |
$2,384 |
$2,384 |
$954 |
$47 | |
| Blood type test |
$526 |
$526 |
$4 |
$3 | |
| Blood type test (ABO group) |
$548 |
$548 |
$4 |
$3 | |
| Bone density scan (DEXA) |
$1,074 |
$1,074 |
$245 |
$39 | |
| Bone marrow biopsy |
$7,021 |
$7,021 |
$2,287 |
$172 | |
| Bone scan (nuclear) |
$10,388 |
$10,388 |
$849 |
$259 | |
| Botox for migraine |
— |
— |
$1,454 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$20,013 |
$1,023 | |
| Breast biopsy |
— |
— |
$3,171 |
$478 | |
| Breast MRI |
— |
— |
$396 |
$216 | |
| Breast MRI without contrast |
— |
— |
$313 |
$216 | |
| Breast reconstruction |
— |
— |
$16,500 |
$1,227 | |
| Breast reduction |
— |
— |
$8,852 |
$980 | |
| Breast ultrasound |
$782 |
$782 |
$329 |
$92 | |
| Breast ultrasound (complete) |
$907 |
$907 |
$388 |
$100 | |
| Breast ultrasound (limited) |
$598 |
$598 |
$329 |
$84 | |
| Breathing tube insertion (intubation) |
— |
— |
$1,454 |
$133 | |
| Bronchoscopy |
— |
— |
$2,702 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$7,679 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$1,454 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$1,454 |
$93 | |
| Burn treatment |
— |
— |
$1,454 |
$129 | |
| CA 19-9 tumor marker test |
$940 |
$940 |
$23 |
$21 | |
| CA-125 ovarian marker test |
$1,133 |
$1,133 |
$23 |
$21 | |
| Capsule endoscopy |
$3,624 |
$3,624 |
$2,126 |
$802 | |
| Cardiac ablation |
$72,661 |
$72,661 |
$40,783 |
$759 | |
| Cardiac catheterization |
$52,853 |
$52,853 |
$15,208 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$1,000 |
$170 | |
| Cardiac MRI |
$9,187 |
$9,187 |
$828 |
$322 | |
| Cardiac MRI without contrast |
$6,812 |
$6,812 |
$860 |
$280 | |
| Cardiac rehabilitation |
$761 |
$761 |
$265 |
$26 | |
| Cardiac stress test |
$1,321 |
$1,321 |
$671 |
$39 | |
| Cardioversion |
$8,181 |
$8,181 |
$2,012 |
$155 | |
| Carotid artery surgery |
— |
— |
$16,144 |
$1,026 | |
| Carotid artery ultrasound |
$3,263 |
$3,263 |
$923 |
$156 | |
| Carpal tunnel release |
— |
— |
$3,816 |
$483 | |
| Cataract surgery |
— |
— |
$4,807 |
$547 | |
| CEA tumor marker test |
$805 |
$805 |
$21 |
$19 | |
| Central line placement |
$8,192 |
$8,192 |
$2,808 |
$238 | |
| Cervical cerclage |
— |
— |
$3,553 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$3,016 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$11,029 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$1,454 |
$131 | |
| Chemotherapy infusion |
$441 |
$441 |
$164 |
$81 | |
| Chemotherapy infusion (each additional) |
$222 |
$222 |
$122 |
$28 | |
| Chemotherapy infusion (first hour) |
$661 |
$661 |
$364 |
$133 | |
| Chest fluid drain (thoracentesis) |
$2,720 |
$2,720 |
$1,797 |
$311 | |
| Chest tube insertion |
$2,263 |
$2,263 |
$2,300 |
$143 | |
| Chest X-ray |
$1,007 |
$1,007 |
$172 |
$37 | |
| Chest X-ray (1 view) |
$901 |
$901 |
$159 |
$25 | |
| Chest X-ray (2 views) |
$977 |
$977 |
$172 |
$33 | |
| Chickenpox (varicella) vaccine |
— |
— |
$380 |
— | |
| Chiropractic adjustment |
— |
— |
$93 |
$38 | |
| Circumcision |
— |
— |
$3,650 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$20,013 |
$1,238 | |
| Colonoscopy |
— |
— |
$2,391 |
$480 | |
| Colostomy |
— |
— |
$20,013 |
$1,122 | |
| Colposcopy |
— |
— |
$1,454 |
$161 | |
| Complete blood count (CBC) (complete) |
— |
— |
$8 |
$8 | |
| Complex wound repair |
— |
— |
$1,556 |
$390 | |
| Comprehensive eye exam |
— |
— |
$457 |
$138 | |
| Contact lens fitting |
— |
— |
$297 |
— | |
| Continuous glucose monitor setup |
— |
— |
$177 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$1,454 |
$115 | |
| Corneal transplant |
— |
— |
$8,820 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$35,000 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$50,702 |
$36,593 | |
| Coronary CT angiography |
$10,609 |
$10,609 |
$1,231 |
$326 | |
| Cortisol test |
$895 |
$895 |
$18 |
$16 | |
| COVID-19 PCR test |
$74 |
$74 |
$51 |
$51 | |
| CPAP titration study |
$4,201 |
$4,201 |
$1,891 |
$69 | |
| Craniotomy (brain surgery) |
— |
— |
$20,013 |
$2,161 | |
| CT angiography of the chest |
$10,324 |
$10,324 |
$856 |
$281 | |
| CT angiography of the head |
$9,612 |
$9,612 |
$4,325 |
$274 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$949 |
$835 | |
| CT scan of the abdomen |
$9,733 |
$9,733 |
$831 |
$230 | |
| CT scan of the abdomen and pelvis |
$13,471 |
$13,471 |
$1,485 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$16,912 |
$16,912 |
$1,485 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$13,471 |
$13,471 |
$1,485 |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$11,908 |
$11,908 |
$951 |
$183 | |
| CT scan of the abdomen with and without contrast |
$11,522 |
$11,522 |
$831 |
$259 | |
| CT scan of the abdomen with contrast |
$9,733 |
$9,733 |
$828 |
$230 | |
| CT scan of the abdomen without contrast |
$8,670 |
$8,670 |
$828 |
$136 | |
| CT scan of the arm |
$10,486 |
$10,486 |
$4,224 |
$199 | |
| CT scan of the arm with contrast |
$9,047 |
$9,047 |
$4,768 |
$199 | |
| CT scan of the arm without contrast |
$7,041 |
$7,041 |
$3,710 |
$161 | |
| CT scan of the chest |
$8,418 |
$8,418 |
$828 |
$167 | |
| CT scan of the chest with and without contrast |
$11,430 |
$11,430 |
$828 |
$196 | |
| CT scan of the chest with contrast |
$8,418 |
$8,418 |
$828 |
$167 | |
| CT scan of the chest without contrast |
$8,418 |
$8,418 |
$828 |
$133 | |
| CT scan of the head |
$7,416 |
$7,416 |
$800 |
$148 | |
| CT scan of the head with and without contrast |
$9,569 |
$9,569 |
$828 |
$173 | |
| CT scan of the head with contrast |
$7,416 |
$7,416 |
$828 |
$148 | |
| CT scan of the head without contrast |
$5,752 |
$5,752 |
$777 |
$107 | |
| CT scan of the leg |
$8,561 |
$8,561 |
$3,764 |
$166 | |
| CT scan of the leg with contrast |
$8,561 |
$8,561 |
$3,852 |
$166 | |
| CT scan of the leg without contrast |
$7,011 |
$7,011 |
$3,155 |
$130 | |
| CT scan of the lower back (lumbar spine) |
$8,418 |
$8,418 |
$856 |
$169 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
$9,681 |
$9,681 |
$842 |
$197 | |
| CT scan of the lower back (lumbar spine) with contrast |
$8,418 |
$8,418 |
$1,136 |
$169 | |
| CT scan of the lower back (lumbar spine) without contrast |
$7,918 |
$7,918 |
$828 |
$130 | |
| CT scan of the neck |
$7,631 |
$7,631 |
$810 |
$183 | |
| CT scan of the neck (cervical spine) |
$8,130 |
$8,130 |
$856 |
$168 | |
| CT scan of the neck (cervical spine) with and without contrast |
$9,495 |
$9,495 |
$844 |
$196 | |
| CT scan of the neck (cervical spine) with contrast |
$8,130 |
$8,130 |
$1,098 |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$6,330 |
$6,330 |
$827 |
$131 | |
| CT scan of the neck with and without contrast |
$8,629 |
$8,629 |
$828 |
$220 | |
| CT scan of the neck with contrast |
$7,631 |
$7,631 |
$828 |
$183 | |
| CT scan of the neck without contrast |
$6,078 |
$6,078 |
$810 |
$150 | |
| CT scan of the pelvis |
$7,485 |
$7,485 |
$828 |
$226 | |
| CT scan of the pelvis with and without contrast |
$10,786 |
$10,786 |
$828 |
$251 | |
| CT scan of the pelvis with contrast |
$7,485 |
$7,485 |
$828 |
$226 | |
| CT scan of the pelvis without contrast |
$6,476 |
$6,476 |
$828 |
$133 | |
| CT scan of the sinuses |
$6,325 |
$6,325 |
$794 |
$152 | |
| CT scan of the sinuses with and without contrast |
$8,506 |
$8,506 |
$828 |
$184 | |
| CT scan of the sinuses with contrast |
$6,325 |
$6,325 |
$827 |
$152 | |
| CT scan of the sinuses without contrast |
$5,674 |
$5,674 |
$766 |
$128 | |
| Defibrillator (ICD) implant |
$45,595 |
$45,595 |
$24,684 |
$798 | |
| Developmental screening (child) |
$187 |
$187 |
$76 |
— | |
| Diagnostic mammogram |
$925 |
$925 |
$148 |
$140 | |
| Dialysis fistula creation |
— |
— |
$6,402 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$3,682 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$4,807 |
$745 | |
| Ear pressure test (tympanometry) |
— |
— |
$132 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$2,152 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$10,705 |
$799 | |
| Echocardiogram |
$4,637 |
$4,637 |
$913 |
$138 | |
| Echocardiogram with and without contrast |
$4,637 |
$4,637 |
$923 |
$101 | |
| Echocardiogram without contrast |
$3,975 |
$3,975 |
$153 |
$138 | |
| EEG (awake and asleep) |
$2,697 |
$2,697 |
$1,205 |
$482 | |
| EKG / ECG (tracing only) |
$696 |
$696 |
$278 |
$7 | |
| Elbow replacement |
— |
— |
$13,318 |
$1,301 | |
| Electrocardiogram (EKG) |
$696 |
$696 |
$259 |
$8 | |
| Electroencephalogram (EEG) |
$3,328 |
$3,328 |
$1,385 |
$448 | |
| Electromyography (EMG) |
— |
— |
$531 |
$141 | |
| Emergency department visit |
$2,812 |
$2,812 |
$1,051 |
$69 | |
| Emergency department visit (level 1) |
$927 |
$927 |
$457 |
$11 | |
| Emergency department visit (level 2) |
$1,699 |
$1,699 |
$845 |
$40 | |
| Emergency department visit (level 3) |
$2,812 |
$2,812 |
$1,359 |
$69 | |
| Emergency department visit (level 4) |
$4,180 |
$4,180 |
$2,931 |
$118 | |
| Emergency department visit (level 5) |
$6,761 |
$6,761 |
$4,720 |
$171 | |
| Endometrial biopsy |
— |
— |
$1,454 |
$98 | |
| Epidural steroid injection |
— |
— |
$1,869 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$3,816 |
$311 | |
| Esophageal dilation |
— |
— |
$2,459 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,613 |
$126 | |
| Estradiol (estrogen) test |
$1,033 |
$1,033 |
$30 |
$28 | |
| Eye refraction (glasses prescription) |
— |
— |
$97 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$3,682 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$2,012 |
$99 | |
| Fallopian tube X-ray (HSG) |
$1,539 |
$1,539 |
$907 |
$164 | |
| Family therapy session |
— |
— |
$27 |
$110 | |
| Fecal occult blood (stool) test |
$366 |
$366 |
$16 |
$10 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
— |
— |
$17 |
$16 | |
| Feeding tube (PEG) placement |
— |
— |
$2,459 |
$178 | |
| Femoral hernia repair |
— |
— |
$7,183 |
$584 | |
| Ferritin (iron) test |
$656 |
$656 |
$15 |
$14 | |
| Fibroid removal (myomectomy) |
— |
— |
$10,918 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$1,765 |
$323 | |
| Flu test |
$584 |
$584 |
$41 |
$17 | |
| Flu vaccine |
$187 |
$187 |
$101 |
— | |
| Folate (folic acid) test |
$366 |
$366 |
$16 |
$15 | |
| Foreign body removal (skin) |
— |
— |
$1,454 |
$157 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$9,417 |
$658 | |
| Gallbladder scan (HIDA) |
$6,492 |
$6,492 |
$919 |
$334 | |
| Ganglion cyst removal |
— |
— |
$4,036 |
$321 | |
| Glaucoma surgery |
— |
— |
$4,807 |
$984 | |
| Group therapy session |
$575 |
$575 |
$194 |
$30 | |
| H. pylori test |
— |
— |
$71 |
$67 | |
| Hammertoe repair |
— |
— |
$6,324 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$527 |
$36 | |
| Hemodialysis |
$721 |
$721 |
$577 |
$75 | |
| Hemorrhoid removal |
— |
— |
$2,300 |
$338 | |
| Hepatitis B vaccine |
$317 |
$317 |
$163 |
— | |
| Hip arthroscopy |
— |
— |
$9,417 |
$931 | |
| Hip fracture repair |
— |
— |
$20,013 |
$1,120 | |
| Hip replacement |
— |
— |
$24,821 |
$1,162 | |
| HIV test (antigen/antibody combo) |
— |
— |
$25 |
$24 | |
| Holter heart monitor |
$1,359 |
$1,359 |
$499 |
$26 | |
| Home sleep apnea test |
— |
— |
$1,927 |
$123 | |
| HPV vaccine |
— |
— |
$651 |
— | |
| Hydrocele repair |
— |
— |
$7,183 |
$315 | |
| Hysterectomy |
— |
— |
$15,735 |
$933 | |
| Hysteroscopy |
— |
— |
$5,771 |
$1,270 | |
| Ileostomy |
— |
— |
$20,013 |
$968 | |
| Incisional hernia repair |
— |
— |
$6,054 |
— | |
| Inguinal hernia repair |
— |
— |
$7,183 |
$538 | |
| IUD insertion |
— |
— |
$1,757 |
— | |
| IUD removal |
— |
— |
$1,454 |
$112 | |
| IV infusion therapy |
$911 |
$911 |
$326 |
$44 | |
| IV infusion therapy (each additional) |
$466 |
$466 |
$187 |
$21 | |
| IV infusion therapy (initial) |
$1,490 |
$1,490 |
$596 |
$67 | |
| IVC filter placement |
$18,379 |
$18,379 |
$10,786 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$1,454 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
— |
— |
$1,454 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$1,454 |
$56 | |
| Kidney biopsy |
— |
— |
$2,613 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$20,013 |
$1,164 | |
| Kidney scan (nuclear) |
$5,929 |
$5,929 |
$568 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$2,905 |
$760 | |
| Kidney ultrasound |
$2,667 |
$2,667 |
$901 |
$84 | |
| Kidney ultrasound (limited) |
$3,127 |
$3,127 |
$886 |
$61 | |
| Knee arthroscopy |
— |
— |
$6,324 |
$524 | |
| Knee joint injection |
$1,282 |
$1,282 |
$948 |
$69 | |
| Knee replacement |
— |
— |
$19,441 |
$18,054 | |
| Lactate test |
$753 |
$753 |
$15 |
$12 | |
| Laminectomy (spine) |
— |
— |
$8,517 |
$1,157 | |
| Laryngoscopy |
— |
— |
$1,777 |
$189 | |
| LDL cholesterol test |
— |
— |
$11 |
$11 | |
| Leg artery angiogram |
$6,333 |
$6,333 |
$3,365 |
$149 | |
| Leg artery angioplasty |
$71,348 |
$71,348 |
$18,836 |
— | |
| Leg vein ultrasound (Doppler) |
$1,653 |
$1,653 |
$734 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$1,653 |
$1,653 |
$731 |
$116 | |
| LH hormone test |
$656 |
$656 |
$20 |
$19 | |
| Liver biopsy |
$4,993 |
$4,993 |
$2,746 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$45,979 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$8,778 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$7,828 |
$750 | |
| Lung function test (PFT) |
$2,883 |
$2,883 |
$891 |
$37 | |
| Lung scan (V/Q) |
$6,525 |
$6,525 |
$1,007 |
$291 | |
| Mastectomy |
— |
— |
$9,880 |
$1,021 | |
| Mastoidectomy |
— |
— |
$6,306 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$6,324 |
$714 | |
| MMR vaccine |
$836 |
$836 |
$355 |
— | |
| Mohs skin cancer surgery |
— |
— |
$1,672 |
$535 | |
| MRA of the brain |
$9,932 |
$9,932 |
$1,078 |
$226 | |
| MRA of the brain with contrast |
$9,932 |
$9,932 |
$1,066 |
$226 | |
| MRA of the brain without contrast |
$11,455 |
$11,455 |
$1,485 |
$328 | |
| MRA of the neck |
$9,237 |
$9,237 |
$1,117 |
$245 | |
| MRA of the neck with contrast |
$9,237 |
$9,237 |
$1,146 |
$245 | |
| MRA of the neck without contrast |
$12,599 |
$12,599 |
$1,485 |
$343 | |
| MRI of the abdomen |
$12,616 |
$12,616 |
$1,117 |
$300 | |
| MRI of the abdomen with contrast |
$12,616 |
$12,616 |
$1,193 |
$300 | |
| MRI of the abdomen without contrast |
$11,808 |
$11,808 |
$843 |
$194 | |
| MRI of the ankle |
$9,557 |
$9,557 |
$2,439 |
$261 | |
| MRI of the ankle with contrast |
$9,557 |
$9,557 |
$2,389 |
$261 | |
| MRI of the ankle without contrast |
$8,142 |
$8,142 |
$2,439 |
$222 | |
| MRI of the brain |
$12,865 |
$12,865 |
$1,033 |
$269 | |
| MRI of the brain with contrast |
$12,865 |
$12,865 |
$931 |
$269 | |
| MRI of the brain without contrast |
$10,553 |
$10,553 |
$750 |
$195 | |
| MRI of the chest |
$8,604 |
$8,604 |
$1,314 |
$371 | |
| MRI of the chest with contrast |
$8,604 |
$8,604 |
$1,494 |
$371 | |
| MRI of the chest without contrast |
$12,898 |
$12,898 |
$1,485 |
$466 | |
| MRI of the knee |
$12,093 |
$12,093 |
$4,860 |
$315 | |
| MRI of the knee with contrast |
$10,799 |
$10,799 |
$2,842 |
$315 | |
| MRI of the knee without contrast |
$10,799 |
$10,799 |
$4,908 |
$204 | |
| MRI of the lower back (lumbar spine) |
$12,479 |
$12,479 |
$1,031 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$12,479 |
$12,479 |
$937 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$10,963 |
$10,963 |
$767 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$12,865 |
$12,865 |
$1,036 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$14,802 |
$14,802 |
$1,074 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$12,865 |
$12,865 |
$945 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$10,963 |
$10,963 |
$767 |
$190 | |
| MRI of the neck (cervical spine) |
$12,233 |
$12,233 |
$993 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$14,143 |
$14,143 |
$1,071 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$12,233 |
$12,233 |
$954 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$10,510 |
$10,510 |
$748 |
$191 | |
| MRI of the pelvis |
$11,755 |
$11,755 |
$1,051 |
$268 | |
| MRI of the pelvis with contrast |
$11,755 |
$11,755 |
$1,051 |
$268 | |
| MRI of the pelvis without contrast |
$10,682 |
$10,682 |
$981 |
$227 | |
| MRI of the shoulder |
$11,176 |
$11,176 |
$4,419 |
$313 | |
| MRI of the shoulder with contrast |
$11,176 |
$11,176 |
$2,850 |
$313 | |
| MRI of the shoulder without contrast |
$9,820 |
$9,820 |
$4,419 |
$205 | |
| MRI of the wrist |
$8,395 |
$8,395 |
$3,747 |
$330 | |
| MRI of the wrist with contrast |
$8,327 |
$8,327 |
$2,082 |
$330 | |
| MRI of the wrist without contrast |
$8,395 |
$8,395 |
$2,099 |
$303 | |
| Nebulizer breathing treatment |
$684 |
$684 |
$376 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$15,471 |
$1,410 | |
| Nerve conduction study |
— |
— |
$224 |
$118 | |
| Newborn hospital care |
— |
— |
$285 |
$58 | |
| Nuchal translucency ultrasound |
— |
— |
$141 |
$116 | |
| Nuclear cardiac stress test |
$14,017 |
$14,017 |
$2,938 |
$428 | |
| Occupational therapy evaluation |
$924 |
$924 |
$107 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$1,327 |
$1,327 |
$107 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$580 |
$580 |
$107 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$924 |
$924 |
$107 |
$101 | |
| Office visit (established patient) |
$517 |
$517 |
$163 |
$115 | |
| Office visit (new patient) |
$555 |
$555 |
$210 |
$177 | |
| Office visit, established patient (level 3) |
$501 |
$501 |
$148 |
$95 | |
| Office visit, established patient (level 4) |
$633 |
$633 |
$194 |
$136 | |
| Office visit, new patient (level 3) |
$509 |
$509 |
$178 |
$118 | |
| Office visit, new patient (level 4) |
$640 |
$640 |
$208 |
$177 | |
| Office visit, new patient (level 5) |
$735 |
$735 |
$256 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$5,357 |
$632 | |
| Ovarian cyst removal |
— |
— |
$9,867 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$17,033 |
$822 | |
| Pacemaker insertion |
— |
— |
$21,192 |
$15,506 | |
| Pap smear (cervical screening) |
$192 |
$192 |
$26 |
$20 | |
| Parathyroid hormone (PTH) test |
$1,383 |
$1,383 |
$187 |
$41 | |
| Parathyroid removal |
— |
— |
$8,629 |
$891 | |
| Pelvic ultrasound |
$2,245 |
$2,245 |
$430 |
$78 | |
| Pelvic ultrasound (complete) |
$3,122 |
$3,122 |
$514 |
$105 | |
| Pelvic ultrasound (limited) |
$1,368 |
$1,368 |
$339 |
$51 | |
| PET scan |
$29,270 |
$29,270 |
$3,951 |
— | |
| Physical therapy evaluation |
$794 |
$794 |
$104 |
$98 | |
| Physical therapy evaluation (high complexity) |
$1,337 |
$1,337 |
$104 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$794 |
$794 |
$104 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$5,357 |
$541 | |
| Pneumonia vaccine |
$1,073 |
$1,073 |
$480 |
— | |
| Pregnancy ultrasound |
$3,167 |
$3,167 |
$520 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$3,189 |
$3,189 |
$504 |
$117 | |
| Pregnancy ultrasound (second or third trimester) |
$3,145 |
$3,145 |
$520 |
$136 | |
| Procalcitonin test |
$807 |
$807 |
$30 |
$27 | |
| Prostate biopsy |
— |
— |
$4,092 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$16,185 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$8,852 |
$526 | |
| Psychiatric evaluation |
$844 |
$844 |
$292 |
$188 | |
| Psychotherapy session |
$725 |
$725 |
$244 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$3,682 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$97 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$3,972 |
$462 | |
| Retina scan (OCT) |
— |
— |
$210 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$415 |
$37 | |
| Retinal detachment repair |
— |
— |
$8,820 |
$966 | |
| Rotator cuff repair |
— |
— |
$10,705 |
$792 | |
| Routine eye exam |
— |
— |
$442 |
$88 | |
| RSV vaccine |
— |
— |
$632 |
— | |
| Sacroiliac joint injection |
— |
— |
$1,995 |
$176 | |
| Scoliosis spine X-ray |
$1,268 |
$1,268 |
$213 |
$58 | |
| Scoliosis spine X-ray (1 view) |
$957 |
$957 |
$168 |
$44 | |
| Scoliosis spine X-ray (3 views) |
$1,579 |
$1,579 |
$245 |
$72 | |
| Screening colonoscopy |
$4,632 |
$4,632 |
$2,177 |
$378 | |
| Screening mammogram |
$1,121 |
$1,121 |
$126 |
$126 | |
| Scrotal ultrasound |
$2,657 |
$2,657 |
$468 |
$99 | |
| Semen analysis |
— |
— |
$13 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$6,051 |
$613 | |
| Sex hormone binding globulin test |
$236 |
$236 |
$24 |
$22 | |
| Shingles vaccine |
— |
— |
$982 |
— | |
| Shoulder arthroscopy |
— |
— |
$8,580 |
$962 | |
| Shoulder replacement |
— |
— |
$27,590 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$1,574 |
$114 | |
| Simple wound stitches |
— |
— |
$1,574 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$7,558 |
$224 | |
| Skin biopsy |
— |
— |
$1,454 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$1,454 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$1,217 |
$240 | |
| Skin graft |
— |
— |
$3,502 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$1,628 |
$36 | |
| Skin tag removal |
— |
— |
$1,574 |
$92 | |
| Sleep study (polysomnography) |
— |
— |
$2,209 |
$691 | |
| Small bowel resection |
— |
— |
$20,013 |
$1,136 | |
| Soft tissue ultrasound |
$1,957 |
$1,957 |
$505 |
$64 | |
| Speech therapy |
$341 |
$341 |
$188 |
$76 | |
| Spinal cord stimulator |
— |
— |
$10,472 |
$2,388 | |
| Spinal tap (lumbar puncture) |
— |
— |
$1,781 |
$165 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$17,049 |
$5,803 | |
| Spirometry (lung function test) |
$1,736 |
$1,736 |
$674 |
$30 | |
| Spirometry with bronchodilator |
$4,030 |
$4,030 |
$1,189 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$12,018 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$20,013 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$5,515 |
$475 | |
| Stress echocardiogram |
$10,013 |
$10,013 |
$2,513 |
$209 | |
| Stress echocardiogram (complete) |
$10,013 |
$10,013 |
$2,954 |
$233 | |
| Swallow study |
$301 |
$301 |
$160 |
$85 | |
| Testicle removal (orchiectomy) |
— |
— |
$6,973 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$11,166 |
$1,004 | |
| Thyroid ultrasound |
$2,304 |
$2,304 |
$460 |
$109 | |
| Thyroid uptake scan |
$5,538 |
$5,538 |
$388 |
$145 | |
| Tonsillectomy |
— |
— |
$5,593 |
$252 | |
| Tracheostomy |
— |
— |
$4,036 |
$273 | |
| Transesophageal echocardiogram (TEE) |
$12,663 |
$12,663 |
$2,588 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
$12,663 |
$12,663 |
$3,343 |
$239 | |
| Transvaginal ultrasound |
$1,939 |
$1,939 |
$378 |
$118 | |
| Trigger finger release |
— |
— |
$2,702 |
$630 | |
| Trigger point injection |
— |
— |
$1,454 |
$56 | |
| Trigger point injection (1-2 muscles) |
— |
— |
$1,454 |
$52 | |
| Tubal ligation |
— |
— |
$8,580 |
$333 | |
| Turbinate reduction |
— |
— |
$3,682 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$4,036 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$3,682 |
$575 | |
| Umbilical hernia repair |
— |
— |
$7,168 |
— | |
| Upper GI endoscopy (EGD) |
— |
— |
$2,350 |
$371 | |
| Upper GI series (barium) |
$2,333 |
$2,333 |
$341 |
$128 | |
| Ureteral stent placement |
— |
— |
$4,036 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$8,629 |
$365 | |
| UV light therapy (skin) |
— |
— |
$268 |
$106 | |
| Vaccine administration |
$194 |
$194 |
$85 |
$19 | |
| Vaccine administration (each additional) |
$194 |
$194 |
$72 |
$16 | |
| Vaginal delivery |
— |
— |
$9,254 |
$5,487 | |
| Varicocele repair |
— |
— |
$5,593 |
$327 | |
| Varicose vein ablation |
— |
— |
$6,402 |
$1,018 | |
| Vasectomy |
— |
— |
$3,682 |
$347 | |
| Visual field test |
— |
— |
$415 |
$64 | |
| Vitamin B12 test |
$873 |
$873 |
$16 |
$15 | |
| Vitrectomy (eye) |
— |
— |
$8,820 |
$814 | |
| Vocal cord injection |
— |
— |
$3,816 |
$211 | |
| Wart removal |
— |
— |
$1,574 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$19,500 |
$11,645 | |
| Well-child visit |
$159 |
$159 |
$111 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$20,013 |
$2,871 | |
| Wound debridement |
— |
— |
$1,556 |
$186 | |
| Wrist fracture repair |
— |
— |
$10,716 |
$735 | |
| X-ray of the abdomen |
$1,281 |
$1,281 |
$182 |
$36 | |
| X-ray of the ankle |
$936 |
$936 |
$421 |
$37 | |
| X-ray of the collarbone |
$1,066 |
$1,066 |
$310 |
$33 | |
| X-ray of the elbow |
$1,423 |
$1,423 |
$640 |
$33 | |
| X-ray of the facial bones |
$1,306 |
$1,306 |
$182 |
$39 | |
| X-ray of the foot |
$962 |
$962 |
$433 |
$34 | |
| X-ray of the forearm |
$997 |
$997 |
$449 |
$29 | |
| X-ray of the hand |
$1,157 |
$1,157 |
$521 |
$38 | |
| X-ray of the hip |
$1,268 |
$1,268 |
$478 |
$49 | |
| X-ray of the hip (1 view) |
$957 |
$957 |
$425 |
$34 | |
| X-ray of the hip (3 views) |
$1,268 |
$1,268 |
$430 |
$49 | |
| X-ray of the hip (4 views) |
$2,294 |
$2,294 |
$776 |
$63 | |
| X-ray of the knee |
$1,029 |
$1,029 |
$412 |
$42 | |
| X-ray of the knee (2 views) |
$888 |
$888 |
$400 |
$34 | |
| X-ray of the knee (3 views) |
$861 |
$861 |
$387 |
$42 | |
| X-ray of the knee (4+ views) |
$1,029 |
$1,029 |
$463 |
$49 | |
| X-ray of the lower back (lumbar spine) |
$1,458 |
$1,458 |
$245 |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$1,120 |
$1,120 |
$197 |
$40 | |
| X-ray of the lower back (lumbar spine) (4+ views) |
$1,796 |
$1,796 |
$245 |
$53 | |
| X-ray of the lower leg |
$1,002 |
$1,002 |
$451 |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$1,303 |
$1,303 |
$222 |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$1,260 |
$1,260 |
$222 |
$33 | |
| X-ray of the mid-back (thoracic spine) (3 views) |
$1,346 |
$1,346 |
$237 |
$39 | |
| X-ray of the neck (cervical spine) |
$1,348 |
$1,348 |
$182 |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$1,079 |
$1,079 |
$182 |
$40 | |
| X-ray of the pelvis |
$1,361 |
$1,361 |
$243 |
$36 | |
| X-ray of the pelvis (1 view) |
$990 |
$990 |
$174 |
$28 | |
| X-ray of the ribs |
$1,183 |
$1,183 |
$296 |
$42 | |
| X-ray of the ribs (2 views) |
$1,044 |
$1,044 |
$310 |
$36 | |
| X-ray of the ribs (3 views) |
$1,183 |
$1,183 |
$400 |
$42 | |
| X-ray of the shoulder |
$1,059 |
$1,059 |
$477 |
$36 | |
| X-ray of the skull |
$1,010 |
$1,010 |
$155 |
$40 | |
| X-ray of the upper arm |
$1,089 |
$1,089 |
$490 |
$32 | |
| X-ray of the wrist |
$822 |
$822 |
$370 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$1,516 |
$335 | |