| Achilles tendon repair |
— |
— |
$6,623 |
$624 | |
| ACL knee reconstruction |
— |
— |
$7,207 |
$889 | |
| Acupuncture |
— |
— |
$27 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$126 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$3,272 |
$204 | |
| Allergy patch testing |
— |
— |
$1,057 |
$5 | |
| Allergy testing |
— |
— |
$1,057 |
$4 | |
| Anal fistula repair |
— |
— |
$2,767 |
$541 | |
| Ankle fracture repair |
— |
— |
$7,207 |
$608 | |
| Ankle replacement |
— |
— |
$18,552 |
$885 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$4,132 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$4,132 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$4,402 |
$592 | |
| Bladder function test (urodynamics) |
— |
— |
$673 |
$345 | |
| Bladder tumor removal (TURBT) |
— |
— |
$3,479 |
$236 | |
| Bone marrow biopsy |
— |
— |
$1,729 |
$172 | |
| Bone scan (nuclear) |
— |
— |
$490 |
$259 | |
| Botox for migraine |
— |
— |
$298 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$3,818 |
$1,023 | |
| Breast biopsy |
— |
— |
$1,634 |
$478 | |
| Breast MRI |
— |
— |
$1,226 |
$216 | |
| Breast MRI without contrast |
— |
— |
$305 |
$216 | |
| Breast reconstruction |
— |
— |
$4,902 |
$1,227 | |
| Breast reduction |
— |
— |
$6,269 |
$980 | |
| Bronchoscopy |
— |
— |
$1,863 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$3,684 |
$883 | |
| Capsule endoscopy |
— |
— |
$1,040 |
$802 | |
| Cardiac ablation |
— |
— |
$24,748 |
$759 | |
| Cardiac catheterization |
— |
— |
$3,569 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$996 |
$170 | |
| Cardiac MRI |
— |
— |
$411 |
$322 | |
| Cardiac MRI without contrast |
— |
— |
$309 |
$280 | |
| Cardiac rehabilitation |
— |
— |
$127 |
$26 | |
| Cardiac stress test |
— |
— |
$319 |
$39 | |
| Carotid artery surgery |
— |
— |
$3,925 |
$1,026 | |
| Carotid artery ultrasound |
— |
— |
$135 |
$156 | |
| Carpal tunnel release |
— |
— |
$1,970 |
$483 | |
| Cataract surgery |
— |
— |
$2,301 |
$547 | |
| Cervical cerclage |
— |
— |
$3,208 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$3,208 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$6,390 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$302 |
$131 | |
| Chickenpox (varicella) vaccine |
— |
— |
$735 |
— | |
| Chiropractic adjustment |
— |
— |
$27 |
$38 | |
| Circumcision |
— |
— |
$2,067 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$4,132 |
$1,238 | |
| Colostomy |
— |
— |
$3,925 |
$1,122 | |
| Colposcopy |
— |
— |
$307 |
$161 | |
| Comprehensive eye exam |
— |
— |
$137 |
$138 | |
| Contact lens fitting |
— |
— |
$295 |
— | |
| Continuous glucose monitor setup |
— |
— |
$177 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$259 |
$115 | |
| Corneal transplant |
— |
— |
$4,058 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$9,788 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$39,130 |
$36,593 | |
| Coronary CT angiography |
— |
— |
$360 |
$326 | |
| Craniotomy (brain surgery) |
— |
— |
$4,132 |
$2,161 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$383 |
$835 | |
| Defibrillator (ICD) implant |
— |
— |
$23,055 |
$798 | |
| Dialysis fistula creation |
— |
— |
$3,175 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$3,208 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$2,353 |
$745 | |
| Drug screen (urine) |
— |
— |
$18 |
$17 | |
| Ear tubes (myringotomy) |
— |
— |
$555 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$5,968 |
$799 | |
| EEG (awake and asleep) |
— |
— |
$336 |
$482 | |
| Elbow replacement |
— |
— |
$10,930 |
$1,301 | |
| Electrocardiogram (EKG) |
— |
— |
$64 |
$8 | |
| Electroencephalogram (EEG) |
— |
— |
$336 |
$448 | |
| Electromyography (EMG) |
— |
— |
$139 |
$141 | |
| Endometrial biopsy |
— |
— |
$203 |
$98 | |
| Epidural steroid injection |
— |
— |
$699 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$3,838 |
$311 | |
| Esophageal dilation |
— |
— |
$1,425 |
$522 | |
| Esophageal variceal banding |
— |
— |
$1,914 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$96 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$1,845 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$979 |
$99 | |
| Family therapy session |
— |
— |
$165 |
$110 | |
| Femoral hernia repair |
— |
— |
$3,560 |
$584 | |
| Fibroid removal (myomectomy) |
— |
— |
$4,132 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$920 |
$323 | |
| Flu test |
— |
— |
$18 |
$17 | |
| Flu vaccine |
— |
— |
$82 |
— | |
| Gallbladder removal (laparoscopic) |
— |
— |
$5,886 |
$658 | |
| Gallbladder scan (HIDA) |
— |
— |
$543 |
$334 | |
| Ganglion cyst removal |
— |
— |
$1,614 |
$321 | |
| Glaucoma surgery |
— |
— |
$2,301 |
$984 | |
| Group therapy session |
— |
— |
$93 |
$30 | |
| H. pylori test |
— |
— |
$72 |
$67 | |
| Hammertoe repair |
— |
— |
$3,273 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$163 |
$36 | |
| Hemodialysis |
— |
— |
$706 |
$75 | |
| Hemorrhoid removal |
— |
— |
$993 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$311 |
— | |
| Hepatitis B vaccine |
— |
— |
$263 |
— | |
| Hip arthroscopy |
— |
— |
$7,207 |
$931 | |
| Hip fracture repair |
— |
— |
$3,829 |
$1,120 | |
| Hip replacement |
— |
— |
$12,980 |
$1,162 | |
| Holter heart monitor |
— |
— |
$419 |
$26 | |
| Home sleep apnea test |
— |
— |
$160 |
$123 | |
| Hydrocele repair |
— |
— |
$3,560 |
$315 | |
| Hysterectomy |
— |
— |
$10,503 |
$933 | |
| Hysteroscopy |
— |
— |
$3,208 |
$1,270 | |
| Ileostomy |
— |
— |
$3,811 |
$968 | |
| Inguinal hernia repair |
— |
— |
$3,560 |
$538 | |
| IUD insertion |
— |
— |
$1,540 |
— | |
| IVC filter placement |
— |
— |
$5,617 |
$1,885 | |
| Kidney biopsy |
— |
— |
$1,634 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$4,132 |
$1,164 | |
| Kidney scan (nuclear) |
— |
— |
$586 |
$172 | |
| Knee arthroscopy |
— |
— |
$3,273 |
$524 | |
| Knee replacement |
— |
— |
$13,793 |
$18,054 | |
| Laminectomy (spine) |
— |
— |
$7,207 |
$1,157 | |
| Leg artery angiogram |
— |
— |
$3,493 |
$149 | |
| Leg artery angioplasty |
— |
— |
$5,752 |
— | |
| Lower back (lumbar) spinal fusion |
— |
— |
$15,028 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$7,207 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$3,999 |
$750 | |
| Lung scan (V/Q) |
— |
— |
$636 |
$291 | |
| Mastectomy |
— |
— |
$6,579 |
$1,021 | |
| Mastoidectomy |
— |
— |
$5,968 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$3,273 |
$714 | |
| MMR vaccine |
— |
— |
$325 |
— | |
| Mohs skin cancer surgery |
— |
— |
$621 |
$535 | |
| Neck (cervical) spinal fusion |
— |
— |
$7,568 |
$1,410 | |
| Nerve conduction study |
— |
— |
$314 |
$118 | |
| Newborn hospital care |
— |
— |
$140 |
$58 | |
| Nuchal translucency ultrasound |
— |
— |
$135 |
$116 | |
| Nuclear cardiac stress test |
— |
— |
$1,672 |
$428 | |
| Occupational therapy evaluation |
— |
— |
$358 |
$101 | |
| Occupational therapy evaluation (high complexity) |
— |
— |
$358 |
$101 | |
| Occupational therapy evaluation (low complexity) |
— |
— |
$358 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
— |
— |
$358 |
$101 | |
| Orthopedic hardware removal |
— |
— |
$2,887 |
$632 | |
| Ovarian cyst removal |
— |
— |
$4,984 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$3,925 |
$822 | |
| Pacemaker insertion |
— |
— |
$16,485 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$29 |
$20 | |
| Parathyroid removal |
— |
— |
$5,964 |
$891 | |
| PET scan |
— |
— |
$1,877 |
— | |
| Physical therapy evaluation |
— |
— |
$358 |
$98 | |
| Physical therapy evaluation (high complexity) |
— |
— |
$358 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
— |
— |
$358 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$2,887 |
$541 | |
| Pneumonia vaccine |
— |
— |
$543 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$10,503 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$5,128 |
$526 | |
| Psychiatric evaluation |
— |
— |
$165 |
$188 | |
| Psychotherapy session |
— |
— |
$165 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$2,353 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$62 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$1,970 |
$462 | |
| Retina scan (OCT) |
— |
— |
$63 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$137 |
$37 | |
| Retinal detachment repair |
— |
— |
$4,058 |
$966 | |
| Rotator cuff repair |
— |
— |
$7,207 |
$792 | |
| Routine eye exam |
— |
— |
$137 |
$88 | |
| RSV vaccine |
— |
— |
$1,055 |
— | |
| Sacroiliac joint injection |
— |
— |
$1,540 |
$176 | |
| Semen analysis |
— |
— |
$14 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$3,272 |
$613 | |
| Shingles vaccine |
— |
— |
$818 |
— | |
| Shoulder arthroscopy |
— |
— |
$7,207 |
$962 | |
| Shoulder replacement |
— |
— |
$18,552 |
$1,300 | |
| Sinus surgery (endoscopic) |
— |
— |
$3,830 |
$224 | |
| Skin graft |
— |
— |
$2,030 |
$898 | |
| Sleep study (polysomnography) |
— |
— |
$1,119 |
$691 | |
| Small bowel resection |
— |
— |
$3,947 |
$1,136 | |
| Speech therapy |
— |
— |
$366 |
$76 | |
| Spinal cord stimulator |
— |
— |
$6,621 |
$2,388 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$7,008 |
$5,803 | |
| Spleen removal (splenectomy) |
— |
— |
$10,356 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$4,132 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$2,542 |
$475 | |
| Stress echocardiogram |
— |
— |
$581 |
$209 | |
| Stress echocardiogram (complete) |
— |
— |
$570 |
$233 | |
| Swallow study |
— |
— |
$360 |
$85 | |
| Tdap (tetanus) vaccine |
$215 |
$651 |
$207 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$3,479 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$5,927 |
$1,004 | |
| Thyroid uptake scan |
— |
— |
$446 |
$145 | |
| Tilt table test |
— |
— |
$551 |
$168 | |
| Tonsillectomy |
— |
— |
$3,272 |
$252 | |
| Tracheostomy |
— |
— |
$3,468 |
$273 | |
| Transesophageal echocardiogram (TEE) |
— |
— |
$608 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
— |
— |
$608 |
$239 | |
| Trigger finger release |
— |
— |
$1,614 |
$630 | |
| Tubal ligation |
— |
— |
$5,886 |
$333 | |
| Turbinate reduction |
— |
— |
$3,272 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$3,464 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$1,970 |
$575 | |
| Ureteral stent placement |
— |
— |
$3,479 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$5,128 |
$365 | |
| UV light therapy (skin) |
— |
— |
$63 |
$106 | |
| Vaginal delivery |
— |
— |
$4,812 |
$5,487 | |
| Varicocele repair |
— |
— |
$3,479 |
$327 | |
| Varicose vein ablation |
— |
— |
$3,175 |
$1,018 | |
| Vasectomy |
— |
— |
$2,067 |
$347 | |
| Visual field test |
— |
— |
$137 |
$64 | |
| Vitrectomy (eye) |
— |
— |
$4,058 |
$814 | |
| Vocal cord injection |
— |
— |
$3,719 |
$211 | |
| Weight-loss (bariatric) surgery |
— |
— |
$11,364 |
$11,645 | |
| Whipple procedure (pancreas) |
— |
— |
$4,132 |
$2,871 | |
| Wrist fracture repair |
— |
— |
$7,008 |
$735 | |
| YAG laser capsulotomy (eye) |
— |
— |
$553 |
$335 | |