| Achilles tendon repair |
— |
— |
$6,428 |
$624 | |
| ACL knee reconstruction |
— |
— |
$6,493 |
$889 | |
| Acupuncture |
— |
— |
$23 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$57 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$2,948 |
$204 | |
| Allergy patch testing |
— |
— |
$925 |
$5 | |
| Allergy shots |
— |
— |
$42 |
$11 | |
| Allergy testing |
— |
— |
$925 |
$4 | |
| Anal fistula repair |
— |
— |
$2,493 |
$541 | |
| Ankle fracture repair |
— |
— |
$6,493 |
$608 | |
| Ankle replacement |
— |
— |
$16,715 |
$885 | |
| Anoscopy |
— |
— |
$137 |
$129 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$3,753 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$3,732 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$7,233 |
$592 | |
| Bladder function test (urodynamics) |
— |
— |
$607 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$613 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$3,135 |
$236 | |
| Blood glucose test |
— |
— |
$5 |
$5 | |
| Bone marrow biopsy |
— |
— |
$2,601 |
$172 | |
| Brain shunt (VP shunt) |
— |
— |
$4,050 |
$1,023 | |
| Breast biopsy |
— |
— |
$1,473 |
$478 | |
| Breast MRI |
— |
— |
$228 |
$216 | |
| Breast reconstruction |
— |
— |
$8,236 |
$1,227 | |
| Breast reduction |
— |
— |
$5,927 |
$980 | |
| Bunion surgery (bunionectomy) |
— |
— |
$4,020 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$244 |
$166 | |
| Burn treatment |
— |
— |
$244 |
$129 | |
| Cardiac ablation |
— |
— |
$22,298 |
$759 | |
| Cardiac catheterization |
— |
— |
$3,011 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$460 |
$170 | |
| Cardiac MRI |
— |
— |
$325 |
$322 | |
| Cardiac MRI without contrast |
— |
— |
$228 |
$280 | |
| Cardiac rehabilitation |
— |
— |
$116 |
$26 | |
| Cardiac stress test |
— |
— |
$421 |
$39 | |
| Carotid artery surgery |
— |
— |
$3,732 |
$1,026 | |
| Carpal tunnel release |
— |
— |
$1,775 |
$483 | |
| Cataract surgery |
— |
— |
$2,094 |
$547 | |
| Cervical cerclage |
— |
— |
$2,890 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$2,890 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$4,861 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$326 |
$131 | |
| Chickenpox (varicella) vaccine |
— |
— |
$172 |
— | |
| Chiropractic adjustment |
— |
— |
$23 |
$38 | |
| Colon resection (colectomy) |
— |
— |
$6,074 |
$1,238 | |
| Colostomy |
— |
— |
$3,732 |
$1,122 | |
| Comprehensive eye exam |
— |
— |
$119 |
$138 | |
| Contact lens fitting |
— |
— |
$134 |
— | |
| Continuous glucose monitor setup |
— |
— |
$121 |
$35 | |
| Corneal transplant |
— |
— |
$3,693 |
$1,066 | |
| Coronary angioplasty / stent (PCI) |
— |
— |
$15,301 |
$426 | |
| Coronary artery bypass (CABG) |
— |
— |
$28,755 |
$36,593 | |
| Craniotomy (brain surgery) |
— |
— |
$3,732 |
$2,161 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$228 |
$835 | |
| Defibrillator (ICD) implant |
— |
— |
$29,141 |
$798 | |
| Developmental screening (child) |
— |
— |
$25 |
— | |
| Dialysis fistula creation |
— |
— |
$2,861 |
$601 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$2,142 |
$745 | |
| Drug screen (urine) |
— |
— |
$17 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$37 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$1,028 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$5,377 |
$799 | |
| Elbow replacement |
— |
— |
$16,715 |
$1,301 | |
| Electrocardiogram (EKG) |
— |
— |
$19 |
$8 | |
| Electromyography (EMG) |
— |
— |
$120 |
$141 | |
| Epidural steroid injection |
— |
— |
$645 |
$275 | |
| Esophageal dilation |
— |
— |
$1,724 |
$522 | |
| Eye refraction (glasses prescription) |
— |
— |
$43 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$1,704 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$890 |
$99 | |
| Family therapy session |
— |
— |
$149 |
$110 | |
| Fecal occult blood (stool) test |
— |
— |
$4 |
$10 | |
| Fecal occult blood (stool) test (guaiac, gFOBT) |
— |
— |
$4 |
$4 | |
| Femoral hernia repair |
— |
— |
$3,208 |
$584 | |
| Fibroid removal (myomectomy) |
— |
— |
$4,311 |
$914 | |
| Flu test |
— |
— |
$17 |
$17 | |
| Flu vaccine |
— |
— |
$21 |
— | |
| Gallbladder removal (laparoscopic) |
— |
— |
$5,356 |
$658 | |
| Ganglion cyst removal |
— |
— |
$1,469 |
$321 | |
| Glaucoma surgery |
— |
— |
$2,094 |
$984 | |
| Group therapy session |
— |
— |
$84 |
$30 | |
| H. pylori test |
— |
— |
$67 |
$67 | |
| Hammertoe repair |
— |
— |
$2,949 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$144 |
$36 | |
| Hemodialysis |
— |
— |
$636 |
$75 | |
| Hemorrhoid removal |
— |
— |
$2,493 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$70 |
— | |
| Hepatitis B vaccine |
— |
— |
$77 |
— | |
| Hip arthroscopy |
— |
— |
$6,493 |
$931 | |
| Hip fracture repair |
— |
— |
$3,810 |
$1,120 | |
| Hip replacement |
— |
— |
$11,695 |
$1,162 | |
| Holter heart monitor |
— |
— |
$235 |
$26 | |
| Home sleep apnea test |
— |
— |
$142 |
$123 | |
| Hydrocele repair |
— |
— |
$3,208 |
$315 | |
| Hysterectomy |
— |
— |
$9,463 |
$933 | |
| Hysteroscopy |
— |
— |
$2,890 |
$1,270 | |
| Ileostomy |
— |
— |
$3,732 |
$968 | |
| Inguinal hernia repair |
— |
— |
$3,208 |
$538 | |
| IVC filter placement |
— |
— |
$4,962 |
$1,885 | |
| Kidney removal (nephrectomy) |
— |
— |
$6,074 |
$1,164 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$3,166 |
$760 | |
| Knee arthroscopy |
— |
— |
$2,979 |
$524 | |
| Knee replacement |
— |
— |
$11,734 |
$18,054 | |
| Laminectomy (spine) |
— |
— |
$6,558 |
$1,157 | |
| Laryngoscopy |
— |
— |
$486 |
$189 | |
| Leg artery angiogram |
— |
— |
$2,861 |
$149 | |
| Leg artery angioplasty |
— |
— |
$5,338 |
— | |
| Lower back (lumbar) spinal fusion |
— |
— |
$28,485 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$6,558 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$3,854 |
$750 | |
| Mastectomy |
— |
— |
$5,927 |
$1,021 | |
| Mastoidectomy |
— |
— |
$5,377 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$2,979 |
$714 | |
| Mohs skin cancer surgery |
— |
— |
$573 |
$535 | |
| MRA of the brain |
— |
— |
$338 |
$226 | |
| MRA of the brain with contrast |
— |
— |
$338 |
$226 | |
| MRA of the neck |
— |
— |
$338 |
$245 | |
| MRA of the neck with contrast |
— |
— |
$338 |
$245 | |
| MRA of the neck without contrast |
— |
— |
$338 |
$343 | |
| MRI of the abdomen |
— |
— |
$338 |
$300 | |
| MRI of the abdomen with contrast |
— |
— |
$338 |
$300 | |
| MRI of the chest |
— |
— |
$711 |
$371 | |
| MRI of the chest with contrast |
— |
— |
$747 |
$371 | |
| MRI of the chest without contrast |
— |
— |
$338 |
$466 | |
| MRI of the knee |
— |
— |
$747 |
$315 | |
| MRI of the knee with contrast |
— |
— |
$747 |
$315 | |
| MRI of the neck (cervical spine) |
— |
— |
$338 |
$274 | |
| MRI of the neck (cervical spine) with contrast |
— |
— |
$338 |
$274 | |
| MRI of the wrist |
— |
— |
$338 |
$330 | |
| MRI of the wrist with contrast |
— |
— |
$338 |
$330 | |
| Neck (cervical) spinal fusion |
— |
— |
$11,695 |
$1,410 | |
| Nerve conduction study |
— |
— |
$283 |
$118 | |
| Newborn hospital care |
— |
— |
$120 |
$58 | |
| Nuclear cardiac stress test |
— |
— |
$1,222 |
$428 | |
| Occupational therapy evaluation |
— |
— |
$181 |
$101 | |
| Occupational therapy evaluation (high complexity) |
— |
— |
$181 |
$101 | |
| Occupational therapy evaluation (low complexity) |
— |
— |
$181 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
— |
— |
$181 |
$101 | |
| Orthopedic hardware removal |
— |
— |
$2,601 |
$632 | |
| Ovarian cyst removal |
— |
— |
$4,487 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$3,943 |
$822 | |
| Pacemaker insertion |
— |
— |
$13,481 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$27 |
$20 | |
| Parathyroid removal |
— |
— |
$5,377 |
$891 | |
| PET scan |
— |
— |
$1,366 |
— | |
| Physical therapy evaluation |
— |
— |
$181 |
$98 | |
| Physical therapy evaluation (high complexity) |
— |
— |
$181 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
— |
— |
$181 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$2,601 |
$541 | |
| Pneumonia vaccine |
— |
— |
$139 |
— | |
| Prostate biopsy |
— |
— |
$1,862 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$9,463 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$4,621 |
$526 | |
| Psychiatric evaluation |
— |
— |
$149 |
$188 | |
| Psychotherapy session |
— |
— |
$149 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$2,120 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$54 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$1,810 |
$462 | |
| Retina scan (OCT) |
— |
— |
$55 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$120 |
$37 | |
| Retinal detachment repair |
— |
— |
$3,656 |
$966 | |
| Rotator cuff repair |
— |
— |
$6,493 |
$792 | |
| Routine eye exam |
— |
— |
$119 |
$88 | |
| RSV vaccine |
— |
— |
$375 |
— | |
| Sacroiliac joint injection |
— |
— |
$1,214 |
$176 | |
| Semen analysis |
— |
— |
$12 |
$12 | |
| Septoplasty (deviated septum) |
— |
— |
$2,948 |
$613 | |
| Shingles vaccine |
— |
— |
$185 |
— | |
| Shoulder arthroscopy |
— |
— |
$6,493 |
$962 | |
| Shoulder replacement |
— |
— |
$16,715 |
$1,300 | |
| Sinus surgery (endoscopic) |
— |
— |
$3,815 |
$224 | |
| Skin biopsy |
— |
— |
$556 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$640 |
$240 | |
| Skin graft |
— |
— |
$2,060 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$186 |
$36 | |
| Sleep study (polysomnography) |
— |
— |
$952 |
$691 | |
| Small bowel resection |
— |
— |
$3,732 |
$1,136 | |
| Speech therapy |
— |
— |
$177 |
$76 | |
| Spinal cord stimulator |
— |
— |
$5,965 |
$2,388 | |
| Spine fracture repair (kyphoplasty) |
— |
— |
$6,493 |
$5,803 | |
| Spleen removal (splenectomy) |
— |
— |
$9,463 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$3,732 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$2,557 |
$475 | |
| Stress echocardiogram |
— |
— |
$503 |
$209 | |
| Stress echocardiogram (complete) |
— |
— |
$503 |
$233 | |
| Swallow study |
— |
— |
$38 |
$85 | |
| Testicle removal (orchiectomy) |
— |
— |
$3,135 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$5,377 |
$1,004 | |
| Tilt table test |
— |
— |
$482 |
$168 | |
| Tonsillectomy |
— |
— |
$3,075 |
$252 | |
| Tracheostomy |
— |
— |
$2,977 |
$273 | |
| Transesophageal echocardiogram (TEE) |
— |
— |
$503 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
— |
— |
$503 |
$239 | |
| Trigger finger release |
— |
— |
$1,469 |
$630 | |
| Tubal ligation |
— |
— |
$5,356 |
$333 | |
| Turbinate reduction |
— |
— |
$2,948 |
$294 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$1,775 |
$575 | |
| Ureteral stent placement |
— |
— |
$3,135 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$4,621 |
$365 | |
| UV light therapy (skin) |
— |
— |
$55 |
$106 | |
| Vaginal delivery |
— |
— |
$3,796 |
$5,487 | |
| Varicocele repair |
— |
— |
$3,135 |
$327 | |
| Varicose vein ablation |
— |
— |
$2,861 |
$1,018 | |
| Vasectomy |
— |
— |
$1,862 |
$347 | |
| Visual field test |
— |
— |
$120 |
$64 | |
| Vitrectomy (eye) |
— |
— |
$3,656 |
$814 | |
| Vocal cord injection |
— |
— |
$3,351 |
$211 | |
| Wart removal |
— |
— |
$185 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$9,589 |
$11,645 | |
| Well-child visit |
— |
— |
$171 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$3,732 |
$2,871 | |
| Wound debridement |
— |
— |
$562 |
$186 | |
| Wrist fracture repair |
— |
— |
$6,493 |
$735 | |
| YAG laser capsulotomy (eye) |
— |
— |
$511 |
$335 | |