| 3D mammogram (tomosynthesis) |
$262 |
$262 |
$92 |
$51 | |
| Abdominal fluid drain (paracentesis) |
$4,125 |
$4,125 |
$2,216 |
$284 | |
| Abdominal ultrasound |
$3,238 |
$3,238 |
$1,271 |
$100 | |
| Abdominal ultrasound (complete) |
$4,101 |
$4,101 |
$1,469 |
$114 | |
| Abdominal ultrasound (limited) |
$3,238 |
$3,238 |
$1,010 |
$86 | |
| Abscess drainage (complex or multiple) |
— |
— |
$1,580 |
$220 | |
| Abscess drainage (simple) |
— |
— |
$1,572 |
$129 | |
| Abscess incision and drainage |
— |
— |
$1,572 |
$174 | |
| Achilles tendon repair |
— |
— |
$8,072 |
$624 | |
| ACL knee reconstruction |
— |
— |
$9,417 |
$889 | |
| Acupuncture |
— |
— |
$106 |
$38 | |
| Acupuncture (each additional) |
— |
— |
$99 |
$28 | |
| Adenoid removal (adenoidectomy) |
— |
— |
$5,761 |
$204 | |
| Allergy patch testing |
— |
— |
$3,463 |
$5 | |
| Allergy shots |
— |
— |
$145 |
$11 | |
| Allergy testing |
— |
— |
$3,463 |
$4 | |
| Alpha-fetoprotein (AFP) test |
$516 |
$516 |
$25 |
$17 | |
| Amniocentesis |
— |
— |
$422 |
$120 | |
| Amylase test |
$359 |
$359 |
$50 |
$6 | |
| Anal fistula repair |
— |
— |
$5,274 |
$541 | |
| Ankle fracture repair |
— |
— |
$8,778 |
$608 | |
| Ankle replacement |
— |
— |
$13,245 |
$885 | |
| Annual physical (established patient) |
— |
— |
$358 |
— | |
| Annual physical (new patient) |
— |
— |
$409 |
— | |
| Anoscopy |
— |
— |
$1,580 |
$129 | |
| Antinuclear antibody (ANA) test |
$318 |
$318 |
$22 |
$12 | |
| Aortic aneurysm repair (AAA) |
— |
— |
$20,013 |
$1,345 | |
| Aortic valve replacement |
— |
— |
$16,144 |
$1,603 | |
| Appendix removal (appendectomy) |
— |
— |
$22,375 |
$592 | |
| Barium swallow study |
$3,087 |
$3,087 |
$698 |
$107 | |
| Bartholin cyst removal |
— |
— |
$1,580 |
$182 | |
| Benign skin lesion removal |
— |
— |
$1,266 |
$171 | |
| Bilirubin blood test |
$291 |
$291 |
$21 |
$5 | |
| Bladder function test (urodynamics) |
— |
— |
$1,469 |
$345 | |
| Bladder scope (cystoscopy) |
— |
— |
$1,566 |
$216 | |
| Bladder tumor removal (TURBT) |
— |
— |
$4,523 |
$236 | |
| Blood transfusion |
$711 |
$711 |
$320 |
$47 | |
| Blood type and screen |
$815 |
$815 |
$57 |
$10 | |
| Blood type test |
$248 |
$248 |
$13 |
$3 | |
| Blood type test (ABO group) |
$179 |
$179 |
$13 |
$3 | |
| Blood type test (Rh/D antigen) |
$317 |
$317 |
$15 |
$3 | |
| Bone density scan (DEXA) |
$2,241 |
$2,241 |
$314 |
$39 | |
| Bone marrow biopsy |
$3,299 |
$3,299 |
$2,012 |
$172 | |
| Bone scan (nuclear) |
$9,938 |
$9,938 |
$1,053 |
$259 | |
| Botox for migraine |
— |
— |
$1,572 |
$157 | |
| Brain shunt (VP shunt) |
— |
— |
$20,013 |
$1,023 | |
| Breast biopsy |
— |
— |
$3,088 |
$478 | |
| Breast MRI |
$6,075 |
$6,075 |
$2,368 |
$216 | |
| Breast MRI without contrast |
$6,334 |
$6,334 |
$1,647 |
$216 | |
| Breast reconstruction |
— |
— |
$18,425 |
$1,227 | |
| Breast reduction |
— |
— |
$9,880 |
$980 | |
| Breast ultrasound |
$908 |
$908 |
$413 |
$92 | |
| Breast ultrasound (complete) |
$3,092 |
$3,092 |
$576 |
$100 | |
| Breast ultrasound (limited) |
$550 |
$550 |
$319 |
$84 | |
| Breathing tube insertion (intubation) |
— |
— |
$1,580 |
$133 | |
| Bronchoscopy |
— |
— |
$2,808 |
$303 | |
| Bunion surgery (bunionectomy) |
— |
— |
$7,679 |
$883 | |
| Burn dressing and debridement (medium) |
— |
— |
$1,626 |
$166 | |
| Burn dressing and debridement (small) |
— |
— |
$1,580 |
$93 | |
| Burn treatment |
— |
— |
$1,580 |
$129 | |
| Capsule endoscopy |
$4,222 |
$4,222 |
$2,273 |
$802 | |
| Cardiac ablation |
$37,851 |
$37,851 |
$29,597 |
$759 | |
| Cardiac catheterization |
$26,861 |
$26,861 |
$12,818 |
$1,049 | |
| Cardiac event monitor |
— |
— |
$1,000 |
$170 | |
| Cardiac MRI |
$3,093 |
$3,093 |
$883 |
$322 | |
| Cardiac MRI without contrast |
$3,093 |
$3,093 |
$518 |
$280 | |
| Cardiac rehabilitation |
$466 |
$466 |
$147 |
$26 | |
| Cardiac stress test |
$5,260 |
$5,260 |
$1,665 |
$39 | |
| Cardioversion |
$3,399 |
$3,399 |
$1,438 |
$155 | |
| Carotid artery surgery |
— |
— |
$16,144 |
$1,026 | |
| Carotid artery ultrasound |
$7,011 |
$7,011 |
$1,960 |
$156 | |
| Carpal tunnel release |
— |
— |
$3,816 |
$483 | |
| Cataract surgery |
— |
— |
$4,807 |
$547 | |
| Central line placement |
$12,108 |
$12,108 |
$3,553 |
$238 | |
| Cervical cerclage |
— |
— |
$3,682 |
$137 | |
| Cervical LEEP procedure |
— |
— |
$3,016 |
$325 | |
| Cesarean section (C-section) |
— |
— |
$9,985 |
$7,552 | |
| Chalazion (eyelid cyst) removal |
— |
— |
$1,580 |
$131 | |
| Chemotherapy infusion |
$287 |
$287 |
$106 |
$81 | |
| Chemotherapy infusion (each additional) |
$154 |
$154 |
$82 |
$28 | |
| Chemotherapy infusion (first hour) |
$398 |
$398 |
$219 |
$133 | |
| Chest fluid drain (thoracentesis) |
$5,156 |
$5,156 |
$1,860 |
$311 | |
| Chest tube insertion |
$3,585 |
$3,585 |
$2,515 |
$143 | |
| Chest X-ray |
$1,481 |
$1,481 |
$518 |
$37 | |
| Chest X-ray (1 view) |
$1,104 |
$1,104 |
$373 |
$25 | |
| Chest X-ray (2 views) |
$1,481 |
$1,481 |
$535 |
$33 | |
| Chickenpox (varicella) vaccine |
— |
— |
$380 |
— | |
| Chiropractic adjustment |
— |
— |
$93 |
$38 | |
| Circumcision |
— |
— |
$3,796 |
$167 | |
| Colon resection (colectomy) |
— |
— |
$20,013 |
$1,238 | |
| Colonoscopy |
— |
— |
$2,613 |
$480 | |
| Colostomy |
— |
— |
$20,013 |
$1,122 | |
| Colposcopy |
— |
— |
$1,580 |
$161 | |
| Complete blood count (CBC) (complete) |
— |
— |
$8 |
$8 | |
| Complex wound repair |
— |
— |
$1,626 |
$390 | |
| Comprehensive eye exam |
— |
— |
$457 |
$138 | |
| Contact lens fitting |
— |
— |
$297 |
— | |
| Continuous glucose monitor setup |
— |
— |
$177 |
$35 | |
| Contraceptive implant (Nexplanon) |
— |
— |
$1,572 |
$115 | |
| Corneal transplant |
— |
— |
$8,591 |
$1,066 | |
| Coronary artery bypass (CABG) |
— |
— |
$46,092 |
$36,593 | |
| Coronary CT angiography |
$2,452 |
$2,452 |
$842 |
$326 | |
| Cortisol test |
$596 |
$596 |
$24 |
$16 | |
| COVID-19 PCR test |
$58 |
$58 |
$51 |
$51 | |
| Craniotomy (brain surgery) |
— |
— |
$20,013 |
$2,161 | |
| Creatine kinase (CK) test |
$288 |
$288 |
$10 |
$7 | |
| CT angiography of the chest |
$11,277 |
$11,277 |
$5,074 |
$281 | |
| CT angiography of the head |
$12,834 |
$12,834 |
$5,775 |
$274 | |
| CT colonography (virtual colonoscopy) |
— |
— |
$956 |
$835 | |
| CT scan of the abdomen |
$11,284 |
$11,284 |
$5,010 |
$230 | |
| CT scan of the abdomen and pelvis |
$15,794 |
$15,794 |
$5,338 |
$300 | |
| CT scan of the abdomen and pelvis with and without contrast |
$20,874 |
$20,874 |
$7,055 |
$338 | |
| CT scan of the abdomen and pelvis with contrast |
$15,794 |
$15,794 |
$5,619 |
$300 | |
| CT scan of the abdomen and pelvis without contrast |
$13,243 |
$13,243 |
$4,850 |
$183 | |
| CT scan of the abdomen with and without contrast |
$14,913 |
$14,913 |
$6,711 |
$259 | |
| CT scan of the abdomen with contrast |
$11,284 |
$11,284 |
$5,078 |
$230 | |
| CT scan of the abdomen without contrast |
$9,463 |
$9,463 |
$4,258 |
$136 | |
| CT scan of the arm |
$12,588 |
$12,588 |
$5,173 |
$199 | |
| CT scan of the arm with contrast |
$7,958 |
$7,958 |
$4,616 |
$199 | |
| CT scan of the arm without contrast |
$7,958 |
$7,958 |
$4,616 |
$161 | |
| CT scan of the chest |
$10,207 |
$10,207 |
$4,532 |
$167 | |
| CT scan of the chest with and without contrast |
$12,802 |
$12,802 |
$5,761 |
$196 | |
| CT scan of the chest with contrast |
$10,207 |
$10,207 |
$4,593 |
$167 | |
| CT scan of the chest without contrast |
$8,708 |
$8,708 |
$3,919 |
$133 | |
| CT scan of the head |
$9,263 |
$9,263 |
$4,162 |
$148 | |
| CT scan of the head with and without contrast |
$12,834 |
$12,834 |
$5,698 |
$173 | |
| CT scan of the head with contrast |
$9,263 |
$9,263 |
$4,113 |
$148 | |
| CT scan of the head without contrast |
$9,250 |
$9,250 |
$4,107 |
$107 | |
| CT scan of the leg |
$11,928 |
$11,928 |
$5,273 |
$166 | |
| CT scan of the leg with contrast |
$8,789 |
$8,789 |
$5,098 |
$166 | |
| CT scan of the leg without contrast |
$7,958 |
$7,958 |
$4,616 |
$130 | |
| CT scan of the lower back (lumbar spine) |
$10,535 |
$10,535 |
$4,741 |
$169 | |
| CT scan of the lower back (lumbar spine) with and without contrast |
$11,326 |
$11,326 |
$5,097 |
$197 | |
| CT scan of the lower back (lumbar spine) with contrast |
$10,355 |
$10,355 |
$4,660 |
$169 | |
| CT scan of the lower back (lumbar spine) without contrast |
$10,535 |
$10,535 |
$4,741 |
$130 | |
| CT scan of the neck |
$9,452 |
$9,452 |
$4,121 |
$183 | |
| CT scan of the neck (cervical spine) |
$11,620 |
$11,620 |
$5,229 |
$168 | |
| CT scan of the neck (cervical spine) with and without contrast |
$12,759 |
$12,759 |
$5,741 |
$196 | |
| CT scan of the neck (cervical spine) with contrast |
$11,620 |
$11,620 |
$5,229 |
$168 | |
| CT scan of the neck (cervical spine) without contrast |
$11,271 |
$11,271 |
$5,072 |
$131 | |
| CT scan of the neck with and without contrast |
$9,962 |
$9,962 |
$4,423 |
$220 | |
| CT scan of the neck with contrast |
$9,452 |
$9,452 |
$4,197 |
$183 | |
| CT scan of the neck without contrast |
$9,158 |
$9,158 |
$4,066 |
$150 | |
| CT scan of the pelvis |
$10,216 |
$10,216 |
$4,536 |
$226 | |
| CT scan of the pelvis with and without contrast |
$12,534 |
$12,534 |
$5,640 |
$251 | |
| CT scan of the pelvis with contrast |
$10,216 |
$10,216 |
$4,597 |
$226 | |
| CT scan of the pelvis without contrast |
$8,817 |
$8,817 |
$3,968 |
$133 | |
| CT scan of the sinuses |
$8,370 |
$8,370 |
$3,541 |
$152 | |
| CT scan of the sinuses with and without contrast |
$9,161 |
$9,161 |
$4,068 |
$184 | |
| CT scan of the sinuses with contrast |
$8,370 |
$8,370 |
$3,716 |
$152 | |
| CT scan of the sinuses without contrast |
$7,868 |
$7,868 |
$3,493 |
$128 | |
| Defibrillator (ICD) implant |
$45,321 |
$45,321 |
$24,926 |
$798 | |
| Developmental screening (child) |
— |
— |
$49 |
— | |
| Diagnostic mammogram |
$1,082 |
$1,082 |
$146 |
$140 | |
| Dialysis fistula creation |
— |
— |
$7,427 |
$601 | |
| Dilation and curettage (D&C) |
— |
— |
$3,806 |
$298 | |
| Droopy eyelid repair (ptosis) |
— |
— |
$4,807 |
$745 | |
| Drug screen (urine) |
$688 |
$688 |
$57 |
$17 | |
| Ear pressure test (tympanometry) |
— |
— |
$132 |
$16 | |
| Ear tubes (myringotomy) |
— |
— |
$2,214 |
$174 | |
| Eardrum repair (tympanoplasty) |
— |
— |
$10,769 |
$799 | |
| Echocardiogram |
$4,140 |
$4,140 |
$1,371 |
$138 | |
| Echocardiogram with and without contrast |
$1,766 |
$1,766 |
$395 |
$101 | |
| Echocardiogram without contrast |
$6,514 |
$6,514 |
$1,922 |
$138 | |
| EEG (awake and asleep) |
$3,604 |
$3,604 |
$1,611 |
$482 | |
| EKG / ECG (tracing only) |
$1,542 |
$1,542 |
$590 |
$7 | |
| Elbow replacement |
— |
— |
$13,318 |
$1,301 | |
| Electrocardiogram (EKG) |
$1,542 |
$1,542 |
$522 |
$8 | |
| Electroencephalogram (EEG) |
$3,442 |
$3,442 |
$1,495 |
$448 | |
| Electromyography (EMG) |
$1,354 |
$1,354 |
$548 |
$141 | |
| Emergency department visit |
$2,951 |
$2,951 |
$1,101 |
$69 | |
| Emergency department visit (level 1) |
$787 |
$787 |
$433 |
$11 | |
| Emergency department visit (level 2) |
$1,653 |
$1,653 |
$909 |
$40 | |
| Emergency department visit (level 3) |
$2,951 |
$2,951 |
$1,435 |
$69 | |
| Emergency department visit (level 4) |
$4,492 |
$4,492 |
$2,629 |
$118 | |
| Emergency department visit (level 5) |
$6,241 |
$6,241 |
$4,485 |
$171 | |
| Endometrial biopsy |
— |
— |
$1,572 |
$98 | |
| Epidural steroid injection |
— |
— |
$1,763 |
$275 | |
| ERCP (bile duct endoscopy) |
— |
— |
$3,854 |
$311 | |
| Esophageal dilation |
— |
— |
$2,514 |
$522 | |
| Esophageal variceal banding |
— |
— |
$2,808 |
$126 | |
| Eye refraction (glasses prescription) |
— |
— |
$97 |
— | |
| Eyelid surgery (blepharoplasty) |
— |
— |
$3,651 |
$552 | |
| Facet joint injection (spine) |
— |
— |
$2,012 |
$99 | |
| Fallopian tube X-ray (HSG) |
$3,020 |
$3,020 |
$1,510 |
$164 | |
| Family therapy session |
— |
— |
$27 |
$110 | |
| Fecal occult blood (stool) test (immunochemical, FIT) |
— |
— |
$17 |
$16 | |
| Feeding tube (PEG) placement |
— |
— |
$2,613 |
$178 | |
| Femoral hernia repair |
— |
— |
$7,168 |
$584 | |
| Fibroid removal (myomectomy) |
— |
— |
$10,918 |
$914 | |
| Flexible sigmoidoscopy |
— |
— |
$1,719 |
$323 | |
| Flu test |
$206 |
$206 |
$53 |
$17 | |
| Flu vaccine |
— |
— |
$122 |
— | |
| Foreign body removal (skin) |
— |
— |
$1,572 |
$157 | |
| Free T4 thyroid test |
$446 |
$446 |
$10 |
$9 | |
| Gallbladder removal (laparoscopic) |
— |
— |
$9,417 |
$658 | |
| Gallbladder scan (HIDA) |
$11,039 |
$11,039 |
$1,189 |
$334 | |
| Ganglion cyst removal |
— |
— |
$3,910 |
$321 | |
| Glaucoma surgery |
— |
— |
$4,807 |
$984 | |
| Glucose tolerance test |
$497 |
$497 |
$14 |
$8 | |
| Group therapy session |
$935 |
$935 |
$349 |
$30 | |
| H. pylori test |
— |
— |
$71 |
$67 | |
| Hammertoe repair |
— |
— |
$6,159 |
$548 | |
| Hearing test (audiometry) |
— |
— |
$527 |
$36 | |
| Hemodialysis |
$6,668 |
$6,668 |
$2,060 |
$75 | |
| Hemorrhoid removal |
— |
— |
$2,300 |
$338 | |
| Hepatitis A vaccine |
— |
— |
$121 |
— | |
| Hepatitis B test |
$359 |
$359 |
$16 |
$10 | |
| Hepatitis B vaccine |
$429 |
$429 |
$196 |
— | |
| Hip arthroscopy |
— |
— |
$9,417 |
$931 | |
| Hip fracture repair |
— |
— |
$20,013 |
$1,120 | |
| Hip replacement |
— |
— |
$24,821 |
$1,162 | |
| HIV test |
$393 |
$393 |
$25 |
$19 | |
| HIV test (antibody) |
$123 |
$123 |
$15 |
$14 | |
| HIV test (antigen/antibody combo) |
$393 |
$393 |
$26 |
$24 | |
| Home sleep apnea test |
— |
— |
$1,927 |
$123 | |
| HPV vaccine |
— |
— |
$651 |
— | |
| Hydrocele repair |
— |
— |
$6,996 |
$315 | |
| Hysterectomy |
— |
— |
$16,144 |
$933 | |
| Hysteroscopy |
— |
— |
$5,621 |
$1,270 | |
| Ileostomy |
— |
— |
$20,013 |
$968 | |
| Incisional hernia repair |
— |
— |
$6,054 |
— | |
| Inguinal hernia repair |
— |
— |
$7,168 |
$538 | |
| IUD insertion |
— |
— |
$1,580 |
— | |
| IUD removal |
— |
— |
$1,580 |
$112 | |
| IV infusion therapy |
$414 |
$414 |
$169 |
$44 | |
| IV infusion therapy (each additional) |
$314 |
$314 |
$126 |
$21 | |
| IV infusion therapy (initial) |
$514 |
$514 |
$228 |
$67 | |
| IVC filter placement |
$8,262 |
$8,262 |
$8,656 |
$1,885 | |
| Joint aspiration (small/intermediate) |
— |
— |
$1,580 |
$57 | |
| Joint aspiration or injection (mid-size joint) |
— |
— |
$1,580 |
$57 | |
| Joint aspiration or injection (small joint) |
— |
— |
$1,580 |
$56 | |
| Kidney biopsy |
$4,910 |
$4,910 |
$2,701 |
$492 | |
| Kidney removal (nephrectomy) |
— |
— |
$20,013 |
$1,164 | |
| Kidney scan (nuclear) |
$9,761 |
$9,761 |
$612 |
$172 | |
| Kidney stone shock-wave (lithotripsy) |
— |
— |
$2,905 |
$760 | |
| Kidney ultrasound |
$3,376 |
$3,376 |
$1,317 |
$84 | |
| Kidney ultrasound (limited) |
$3,376 |
$3,376 |
$1,488 |
$61 | |
| Knee arthroscopy |
— |
— |
$6,159 |
$524 | |
| Knee joint injection |
$2,169 |
$2,169 |
$1,518 |
$69 | |
| Knee replacement |
— |
— |
$17,923 |
$18,054 | |
| Lactate test |
$592 |
$592 |
$47 |
$12 | |
| Laminectomy (spine) |
— |
— |
$8,858 |
$1,157 | |
| Laryngoscopy |
— |
— |
$1,993 |
$189 | |
| LDH test |
$346 |
$346 |
$24 |
$6 | |
| LDL cholesterol test |
— |
— |
$11 |
$11 | |
| Leg artery angiogram |
$5,388 |
$5,388 |
$2,877 |
$149 | |
| Leg artery angioplasty |
$49,523 |
$49,523 |
$10,763 |
— | |
| Leg vein ultrasound (Doppler) |
$4,046 |
$4,046 |
$1,821 |
$150 | |
| Leg vein ultrasound (Doppler) (limited) |
$4,046 |
$4,046 |
$1,797 |
$116 | |
| Lipid (cholesterol) panel |
$499 |
$499 |
$35 |
$13 | |
| Liver biopsy |
$3,572 |
$3,572 |
$2,613 |
$288 | |
| Lower back (lumbar) spinal fusion |
— |
— |
$44,799 |
$1,511 | |
| Lumbar discectomy |
— |
— |
$8,858 |
$898 | |
| Lumpectomy (breast) |
— |
— |
$8,024 |
$750 | |
| Lung function test (PFT) |
$3,277 |
$3,277 |
$1,080 |
$37 | |
| Lung scan (V/Q) |
$7,803 |
$7,803 |
$1,101 |
$291 | |
| Magnesium blood test |
$388 |
$388 |
$54 |
$7 | |
| Mastectomy |
— |
— |
$9,880 |
$1,021 | |
| Mastoidectomy |
— |
— |
$6,451 |
$840 | |
| Meniscus repair (knee) |
— |
— |
$6,159 |
$714 | |
| MMR vaccine |
$541 |
$541 |
$242 |
— | |
| Mohs skin cancer surgery |
— |
— |
$1,995 |
$535 | |
| MRA of the brain |
$6,943 |
$6,943 |
$1,078 |
$226 | |
| MRA of the brain with contrast |
$6,943 |
$6,943 |
$1,066 |
$226 | |
| MRA of the brain without contrast |
$9,706 |
$9,706 |
$1,422 |
$328 | |
| MRA of the neck |
$6,943 |
$6,943 |
$1,117 |
$245 | |
| MRA of the neck with contrast |
$6,943 |
$6,943 |
$1,146 |
$245 | |
| MRA of the neck without contrast |
$9,027 |
$9,027 |
$1,400 |
$343 | |
| MRI of the abdomen |
$12,233 |
$12,233 |
$1,193 |
$300 | |
| MRI of the abdomen with contrast |
$12,233 |
$12,233 |
$1,193 |
$300 | |
| MRI of the abdomen without contrast |
$12,233 |
$12,233 |
$907 |
$194 | |
| MRI of the ankle |
$11,739 |
$11,739 |
$5,033 |
$261 | |
| MRI of the ankle with contrast |
$11,245 |
$11,245 |
$4,387 |
$261 | |
| MRI of the ankle without contrast |
$10,066 |
$10,066 |
$4,530 |
$222 | |
| MRI of the brain |
$12,494 |
$12,494 |
$1,117 |
$269 | |
| MRI of the brain with contrast |
$12,494 |
$12,494 |
$1,045 |
$269 | |
| MRI of the brain without contrast |
$10,417 |
$10,417 |
$907 |
$195 | |
| MRI of the chest |
$10,888 |
$10,888 |
$1,494 |
$371 | |
| MRI of the chest with contrast |
$10,888 |
$10,888 |
$1,609 |
$371 | |
| MRI of the chest without contrast |
$13,503 |
$13,503 |
$1,631 |
$466 | |
| MRI of the knee |
$12,275 |
$12,275 |
$5,684 |
$315 | |
| MRI of the knee with contrast |
$11,368 |
$11,368 |
$5,116 |
$315 | |
| MRI of the knee without contrast |
$10,395 |
$10,395 |
$5,478 |
$204 | |
| MRI of the lower back (lumbar spine) |
$12,494 |
$12,494 |
$1,068 |
$270 | |
| MRI of the lower back (lumbar spine) with contrast |
$12,494 |
$12,494 |
$1,117 |
$270 | |
| MRI of the lower back (lumbar spine) without contrast |
$10,417 |
$10,417 |
$907 |
$192 | |
| MRI of the mid-back (thoracic spine) |
$11,798 |
$11,798 |
$1,117 |
$271 | |
| MRI of the mid-back (thoracic spine) with and without contrast |
$15,815 |
$15,815 |
$1,210 |
$319 | |
| MRI of the mid-back (thoracic spine) with contrast |
$11,798 |
$11,798 |
$1,117 |
$271 | |
| MRI of the mid-back (thoracic spine) without contrast |
$10,417 |
$10,417 |
$907 |
$190 | |
| MRI of the neck (cervical spine) |
$12,233 |
$12,233 |
$1,071 |
$274 | |
| MRI of the neck (cervical spine) with and without contrast |
$15,263 |
$15,263 |
$1,117 |
$318 | |
| MRI of the neck (cervical spine) with contrast |
$12,233 |
$12,233 |
$1,117 |
$274 | |
| MRI of the neck (cervical spine) without contrast |
$10,417 |
$10,417 |
$907 |
$191 | |
| MRI of the pelvis |
$10,725 |
$10,725 |
$1,117 |
$268 | |
| MRI of the pelvis with contrast |
$10,725 |
$10,725 |
$1,117 |
$268 | |
| MRI of the pelvis without contrast |
$9,286 |
$9,286 |
$981 |
$227 | |
| MRI of the shoulder |
$11,007 |
$11,007 |
$4,970 |
$313 | |
| MRI of the shoulder with contrast |
$9,714 |
$9,714 |
$4,371 |
$313 | |
| MRI of the shoulder without contrast |
$9,431 |
$9,431 |
$4,970 |
$205 | |
| MRI of the wrist |
$10,760 |
$10,760 |
$4,655 |
$330 | |
| MRI of the wrist with contrast |
$8,834 |
$8,834 |
$3,975 |
$330 | |
| MRI of the wrist without contrast |
$9,027 |
$9,027 |
$4,062 |
$303 | |
| Nebulizer breathing treatment |
$791 |
$791 |
$320 |
$9 | |
| Neck (cervical) spinal fusion |
— |
— |
$15,828 |
$1,410 | |
| Nerve conduction study |
— |
— |
$224 |
$118 | |
| Newborn hospital care |
— |
— |
$285 |
$58 | |
| Nuchal translucency ultrasound |
— |
— |
$147 |
$116 | |
| Nuclear cardiac stress test |
$14,687 |
$14,687 |
$1,658 |
$428 | |
| Occupational therapy evaluation |
$521 |
$521 |
$107 |
$101 | |
| Occupational therapy evaluation (high complexity) |
$521 |
$521 |
$105 |
$101 | |
| Occupational therapy evaluation (low complexity) |
$521 |
$521 |
$107 |
$101 | |
| Occupational therapy evaluation (moderate complexity) |
$521 |
$521 |
$105 |
$101 | |
| Office visit (established patient) |
$165 |
$165 |
$80 |
$115 | |
| Office visit (new patient) |
$243 |
$243 |
$131 |
$177 | |
| Office visit, established patient (level 3) |
$132 |
$132 |
$73 |
$95 | |
| Office visit, established patient (level 4) |
$169 |
$169 |
$93 |
$136 | |
| Office visit, new patient (level 3) |
$202 |
$202 |
$107 |
$118 | |
| Office visit, new patient (level 4) |
$238 |
$238 |
$131 |
$177 | |
| Office visit, new patient (level 5) |
$349 |
$349 |
$184 |
$237 | |
| Orthopedic hardware removal |
— |
— |
$5,218 |
$632 | |
| Ovarian cyst removal |
— |
— |
$9,611 |
$698 | |
| Ovary removal (oophorectomy) |
— |
— |
$12,100 |
$822 | |
| Pacemaker insertion |
— |
— |
$17,495 |
$15,506 | |
| Pap smear (cervical screening) |
— |
— |
$25 |
$20 | |
| Parathyroid removal |
— |
— |
$10,772 |
$891 | |
| Pelvic ultrasound |
$1,869 |
$1,869 |
$948 |
$78 | |
| Pelvic ultrasound (complete) |
$3,815 |
$3,815 |
$1,300 |
$105 | |
| Pelvic ultrasound (limited) |
$1,723 |
$1,723 |
$765 |
$51 | |
| PET scan |
$28,164 |
$28,164 |
$5,351 |
— | |
| Physical therapy evaluation |
$347 |
$347 |
$101 |
$98 | |
| Physical therapy evaluation (high complexity) |
$347 |
$347 |
$101 |
$98 | |
| Physical therapy evaluation (moderate complexity) |
$347 |
$347 |
$101 |
$98 | |
| Pilonidal cyst removal |
— |
— |
$5,218 |
$541 | |
| Pneumonia vaccine |
$765 |
$765 |
$403 |
— | |
| Pregnancy ultrasound |
$3,308 |
$3,308 |
$1,211 |
$126 | |
| Pregnancy ultrasound (first trimester) |
$3,308 |
$3,308 |
$1,056 |
$117 | |
| Pregnancy ultrasound (second or third trimester) |
$3,562 |
$3,562 |
$1,445 |
$136 | |
| Procalcitonin test |
$1,447 |
$1,447 |
$30 |
$27 | |
| Prostate biopsy |
— |
— |
$2,214 |
— | |
| Prostate removal (prostatectomy) |
— |
— |
$16,255 |
$1,063 | |
| Prostate surgery (TURP) |
— |
— |
$9,521 |
$526 | |
| Psychiatric evaluation |
— |
— |
$56 |
$188 | |
| Psychotherapy session |
— |
— |
$134 |
$140 | |
| Pterygium removal (eye) |
— |
— |
$3,806 |
$540 | |
| Pulmonary rehabilitation |
— |
— |
$97 |
$87 | |
| Radiofrequency nerve ablation |
— |
— |
$3,869 |
$462 | |
| Retina scan (OCT) |
— |
— |
$210 |
$33 | |
| Retinal (fundus) photography |
— |
— |
$415 |
$37 | |
| Retinal detachment repair |
— |
— |
$9,774 |
$966 | |
| Rotator cuff repair |
— |
— |
$10,769 |
$792 | |
| Routine eye exam |
— |
— |
$442 |
$88 | |
| RSV vaccine |
— |
— |
$632 |
— | |
| Sacroiliac joint injection |
— |
— |
$1,881 |
$176 | |
| Scoliosis spine X-ray |
$850 |
$850 |
$182 |
$58 | |
| Scoliosis spine X-ray (1 view) |
$850 |
$850 |
$220 |
$44 | |
| Scoliosis spine X-ray (3 views) |
— |
— |
$155 |
$72 | |
| Screening colonoscopy |
— |
— |
$2,047 |
$378 | |
| Screening mammogram |
$1,082 |
$1,082 |
$118 |
$126 | |
| Scrotal ultrasound |
$3,287 |
$3,287 |
$1,315 |
$99 | |
| Septoplasty (deviated septum) |
— |
— |
$5,893 |
$613 | |
| Sex hormone binding globulin test |
$490 |
$490 |
$24 |
$22 | |
| Shingles vaccine |
— |
— |
$1,105 |
— | |
| Shoulder arthroscopy |
— |
— |
$8,778 |
$962 | |
| Shoulder replacement |
— |
— |
$27,590 |
$1,300 | |
| Simple laceration repair (small, up to 2.5 cm) |
— |
— |
$1,580 |
$114 | |
| Simple wound stitches |
— |
— |
$1,580 |
$127 | |
| Sinus surgery (endoscopic) |
— |
— |
$7,679 |
$224 | |
| Skin biopsy |
— |
— |
$1,572 |
$121 | |
| Skin biopsy (punch) |
— |
— |
$1,572 |
$121 | |
| Skin cancer lesion removal |
— |
— |
$1,266 |
$240 | |
| Skin graft |
— |
— |
$3,651 |
$898 | |
| Skin lesion freezing (cryotherapy) |
— |
— |
$1,672 |
$36 | |
| Skin tag removal |
— |
— |
$1,580 |
$92 | |
| Sleep study (polysomnography) |
$18,168 |
$18,168 |
$4,943 |
$691 | |
| Small bowel resection |
— |
— |
$20,013 |
$1,136 | |
| Soft tissue ultrasound |
$2,546 |
$2,546 |
$794 |
$64 | |
| Speech therapy |
$290 |
$290 |
$102 |
$76 | |
| Spinal cord stimulator |
— |
— |
$10,472 |
$2,388 | |
| Spinal tap (lumbar puncture) |
$4,227 |
$4,227 |
$1,844 |
$165 | |
| Spine fracture repair (kyphoplasty) |
$50,102 |
$50,102 |
$18,682 |
$5,803 | |
| Spirometry (lung function test) |
$2,402 |
$2,402 |
$776 |
$30 | |
| Spirometry with bronchodilator |
$4,152 |
$4,152 |
$1,314 |
$43 | |
| Spleen removal (splenectomy) |
— |
— |
$12,018 |
$1,036 | |
| Stomach removal (gastrectomy) |
— |
— |
$20,013 |
$1,595 | |
| Strabismus (eye muscle) surgery |
— |
— |
$5,694 |
$475 | |
| Stress echocardiogram |
$14,037 |
$14,037 |
$3,525 |
$209 | |
| Stress echocardiogram (complete) |
$11,948 |
$11,948 |
$4,038 |
$233 | |
| Swallow study |
$301 |
$301 |
$113 |
$85 | |
| Tdap (tetanus) vaccine |
$331 |
$331 |
$147 |
— | |
| Testicle removal (orchiectomy) |
— |
— |
$6,792 |
$306 | |
| Thyroid removal (thyroidectomy) |
— |
— |
$10,895 |
$1,004 | |
| Thyroid ultrasound |
$2,897 |
$2,897 |
$1,159 |
$109 | |
| Tonsillectomy |
— |
— |
$5,893 |
$252 | |
| Total IgE allergy test |
$477 |
$477 |
$18 |
$16 | |
| Tracheostomy |
— |
— |
$4,036 |
$273 | |
| Transesophageal echocardiogram (TEE) |
$13,266 |
$13,266 |
$2,852 |
$239 | |
| Transesophageal echocardiogram (TEE) with and without contrast |
$13,266 |
$13,266 |
$3,696 |
$239 | |
| Transvaginal ultrasound |
$3,177 |
$3,177 |
$1,026 |
$118 | |
| Trigger finger release |
— |
— |
$2,924 |
$630 | |
| Trigger point injection |
— |
— |
$1,580 |
$56 | |
| Trigger point injection (1-2 muscles) |
— |
— |
$1,580 |
$52 | |
| Tubal ligation |
— |
— |
$8,580 |
$333 | |
| Turbinate reduction |
— |
— |
$3,806 |
$294 | |
| Turning a breech baby (version) |
— |
— |
$4,036 |
$94 | |
| Ulnar nerve surgery (elbow) |
— |
— |
$3,806 |
$575 | |
| Umbilical hernia repair |
— |
— |
$7,168 |
— | |
| Upper GI endoscopy (EGD) |
— |
— |
$2,216 |
$371 | |
| Upper GI series (barium) |
$5,095 |
$5,095 |
$1,320 |
$128 | |
| Ureteral stent placement |
— |
— |
$4,036 |
$373 | |
| Ureteroscopy (stone removal) |
— |
— |
$9,521 |
$365 | |
| Urinalysis |
$143 |
$143 |
$37 |
$3 | |
| Urine microalbumin test |
$388 |
$388 |
$10 |
$5 | |
| UV light therapy (skin) |
— |
— |
$268 |
$106 | |
| Vaccine administration |
$74 |
$74 |
$22 |
$19 | |
| Vaccine administration (each additional) |
$40 |
$40 |
$18 |
$16 | |
| Vaginal delivery |
— |
— |
$7,795 |
$5,487 | |
| Varicocele repair |
— |
— |
$5,761 |
$327 | |
| Varicose vein ablation |
— |
— |
$6,235 |
$1,018 | |
| Vasectomy |
— |
— |
$3,806 |
$347 | |
| Visual field test |
— |
— |
$415 |
$64 | |
| Vitamin B12 test |
$715 |
$715 |
$16 |
$15 | |
| Vitamin D test |
$1,006 |
$1,006 |
$32 |
$30 | |
| Vitrectomy (eye) |
— |
— |
$8,852 |
$814 | |
| Vocal cord injection |
— |
— |
$3,816 |
$211 | |
| Wart removal |
— |
— |
$1,580 |
$121 | |
| Weight-loss (bariatric) surgery |
— |
— |
$19,500 |
$11,645 | |
| Well-child visit |
— |
— |
$281 |
— | |
| Whipple procedure (pancreas) |
— |
— |
$20,013 |
$2,871 | |
| Wound debridement |
— |
— |
$1,626 |
$186 | |
| Wrist fracture repair |
— |
— |
$10,716 |
$735 | |
| X-ray of the abdomen |
$1,456 |
$1,456 |
$499 |
$36 | |
| X-ray of the ankle |
$1,531 |
$1,531 |
$842 |
$37 | |
| X-ray of the collarbone |
$1,916 |
$1,916 |
$845 |
$33 | |
| X-ray of the elbow |
$1,651 |
$1,651 |
$908 |
$33 | |
| X-ray of the facial bones |
$1,948 |
$1,948 |
$650 |
$39 | |
| X-ray of the foot |
$1,543 |
$1,543 |
$849 |
$34 | |
| X-ray of the forearm |
$1,568 |
$1,568 |
$862 |
$29 | |
| X-ray of the hand |
$1,445 |
$1,445 |
$795 |
$38 | |
| X-ray of the hip |
$1,402 |
$1,402 |
$425 |
$49 | |
| X-ray of the hip (1 view) |
$966 |
$966 |
$377 |
$34 | |
| X-ray of the hip (3 views) |
$1,599 |
$1,599 |
$560 |
$49 | |
| X-ray of the hip (4 views) |
$1,402 |
$1,402 |
$155 |
$63 | |
| X-ray of the knee |
$1,531 |
$1,531 |
$770 |
$42 | |
| X-ray of the knee (2 views) |
$1,100 |
$1,100 |
$605 |
$34 | |
| X-ray of the knee (3 views) |
$1,448 |
$1,448 |
$796 |
$42 | |
| X-ray of the knee (4+ views) |
$1,805 |
$1,805 |
$993 |
$49 | |
| X-ray of the lower back (lumbar spine) |
$1,857 |
$1,857 |
$743 |
$47 | |
| X-ray of the lower back (lumbar spine) (2 views) |
$1,857 |
$1,857 |
$743 |
$40 | |
| X-ray of the lower back (lumbar spine) (4+ views) |
$2,470 |
$2,470 |
$835 |
$53 | |
| X-ray of the lower leg |
$1,387 |
$1,387 |
$763 |
$31 | |
| X-ray of the mid-back (thoracic spine) |
$2,033 |
$2,033 |
$643 |
$36 | |
| X-ray of the mid-back (thoracic spine) (2 views) |
$1,869 |
$1,869 |
$632 |
$33 | |
| X-ray of the mid-back (thoracic spine) (3 views) |
$2,198 |
$2,198 |
$743 |
$39 | |
| X-ray of the neck (cervical spine) |
$2,042 |
$2,042 |
$613 |
$47 | |
| X-ray of the neck (cervical spine) (3 views) |
$1,716 |
$1,716 |
$580 |
$40 | |
| X-ray of the pelvis |
$1,636 |
$1,636 |
$510 |
$36 | |
| X-ray of the pelvis (1 view) |
$1,306 |
$1,306 |
$449 |
$28 | |
| X-ray of the ribs |
$1,719 |
$1,719 |
$709 |
$42 | |
| X-ray of the ribs (2 views) |
$1,418 |
$1,418 |
$745 |
$36 | |
| X-ray of the ribs (3 views) |
$1,719 |
$1,719 |
$903 |
$42 | |
| X-ray of the shoulder |
$1,677 |
$1,677 |
$884 |
$36 | |
| X-ray of the skull |
$2,001 |
$2,001 |
$617 |
$40 | |
| X-ray of the upper arm |
$1,593 |
$1,593 |
$876 |
$32 | |
| X-ray of the wrist |
$1,445 |
$1,445 |
$795 |
$43 | |
| YAG laser capsulotomy (eye) |
— |
— |
$1,462 |
$335 | |