Skip to main content
300 Shoppable Services
Procedure Name
Psychotherapy W/Patient 30 Minutes-90832
Psychotherapy W/Patient 45 Minutes-90834
Psychotherapy W/Patient 60 Minutes-90837
Family Psychotherapy, Not Including Patient, 50 Min-90846
Family Psychotherapy, Including Patient, 50 Min-90847
Group Psychotherapy-90853
New Patient Office Or Other Outpatient Visit, Typically 30 Min-99203
New Patient Office Of Other Outpatient Visit, Typically 45 Min-99204
New Patient Office Of Other Outpatient Visit, Typically 60 Min-99205
Patient Office Consultation, Typically 40 Min-99243
Patient Office Consultation, Typically 60 Min-99244
Initial New Patient Preventive Medicine Evaluation (18-39 Years)-99385
Initial New Patient Preventive Medicine Evaluation (40-64 Years)-99386
Basic Metabolic Panel-80048
Blood Test, Comprehensive Group Of Blood Chemicals-80053
Obstetric Blood Test Panel-80055
Blood Test, Lipids (Cholesterol And Triglycerides)-80061
Kidney Function Panel Test-80069
Liver Function Blood Test Panel-80076
Manual Urinalysis Test With Examination Using Microscope-81000
Manual Urinalysis Test With Examination Using Microscope-81001
Automated Urinalysis Test-81002
Automated Urinalysis Test-81003
Psa (Prostate Specific Antigen) Total & Free-84153 & 84154
Blood Test, Thyroid Stimulating Hormone (Tsh)-84443
Blood Count Complete Auto&Auto Difrntl Wbc-85025
Complete Blood Count, Automated-85027
Blood Test, Clotting Time-85610
Coagulation Assessment Blood Test-85730
Ct Scan, Head Or Brain, Without Contrast-70450
Mri Scan Of Brain Before And After Contrast-70553
X-Ray, Lower Back, Minimum Four Views-72110
Mri Scan Of Lower Spinal Canal-72148
Ct Scan, Pelvis, With Contrast-72193
Mri Scan Of Leg Joint-73721
Ct Scan Of Abdomen And Pelvis With Contrast-74177
Ultrasound Of Abdomen-76700
Us Pregnant Uterus After 1St Trimest 1/1St Gestation-76805
Ultrasound Pelvis Through Vagina-76830
Mammography Of One Breast, Both Breasts & Screening Bilateral-77065-77067
Cardiac Valve And Other Maj Cardiothoracic Proc W/ Cath And Mcc-216
Spinal Fusion Except Cervical W/O Mcc-460
Maj Hip And Knee Joint Replace Or Reattach Lower Extremity W/O Mcc-470
Cervical Spinal Fusion W/O Cc/Mcc-473
Uterine And Adnexa Proc For Non-Malignancy W/O Cc/Mcc-743
Removal Of 1 Or More Breast Growth, Open Procedure-19120
Shaving Of Shoulder Bone Using An Endoscope-29826
Removal Of One Knee Cartilage Using An Endoscope-29881
Tonsillectomy & Adenoidectomy-42820
Esophagogastroduodenoscopy Transoral Diagnostic-43235
Egd Transoral Biopsy Single/Multiple-43239
Diagnostic Examination Of Large Bowel Using An Endoscope-45378
Biopsy Of Large Bowel Using An Endoscope-45380
Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope-45385
Ultrasound Examination Of Lower Large Bowel Using An Endoscope-45391
Removal Of Gallbladder Using An Endoscope-47562
Repair Of Groin Hernia Patient Age 5 Years Or Older-49505
Biopsy Of Prostate Gland-55700
Laproscopy Prostect Retropubic Rad W/Nrv Sparing Robot-55866
Obstetric Care For Vaginal Delivery, Pre-And Post- Delivery Care-59400
Obstetric Care Cesarean Delivery, Pre-And Post- Delivery Care-59510
Routine Obstetric Care Vaginal Dlvry & Postpartum Care Vb-59610
Injection Substance Spinal Canal Lower Back/Sacrum W/O Img Gdn-62322
Injection Substance Spinal Canal Lower Back/Sacrum W/Img Gdn-62323
Inj Anesthetic &/Steroid Lower/Sacral Spine Nerve Root W/Img Gdn-64483
Removal Of Recurring Cataract In Lens Capsule Using Laser-66821
Removal Of Cataract With Insertion Of Lens-66984
Electrocardiogram, Routine, With Interpretation And Report-93000
Insertion Of Catheter Into Left Heart For Diagnosis-93452
Sleep Study-95810
Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes-97110
Tympanostomy General Anesthesia-69436
Dstrj Neurolytic Agent Other Peripheral Nerve-64640
Adenoidectomy Primary Less Than Age 12-42830
Removal Implant Deep-20680
Arthrs Aided Ant Cruciate Ligm Rpr-Agmntj-Rcnstj-29888
Circumcision Age Greater Than 28 Days-54161
Ophth Xmandeval Anes W-Wo Manj Globe Compl-92018
Chemotx Admn Cns Req Spinal Puncture-96450
Strabismus Recession-Rescj 1 Hrzntl Musc-67311
Laryngoscopy W-Wo Tracheoscopy W-Micro-Telescope-31526
Repair Incomplete Circumcision-54163
Rpr 1St Ingun Hrna Age 6 Mo-5 Yrs Reducible-49500
Laps Fulg-Exc Ovary Viscera-Peritoneal Surface-58662
Orchiopexy Inguinal Or Scrotal Approach-54640
Laparoscopic Appendectomy-44970
Tympanic Memb Rpr W-Wo Prepj Perfor Patch-69610
Dstrj Cutaneous Vascular Lesions Greater Than 50.0 Sq Cm-17108
Rcnstj Dislc Patella W-Xtnsr Relignmtand-Musc Rl-27422
Chemodervate Facial-Trigem-Cerv Musc Migraine-64615
Strabismus Recession-Rescj 1 Ver Musc-67314
Egd Balloon Dilation Esophagus Less Than 30 Mm Diam-43249
Diagnostic Bone Marrow Biopsies And Aspirations-38222
Prq Skel Fixj Sprcndylr-Transcndylr Humeral Fx-24538
Arthroscopy Knee W-Meniscus Rpr Medial-Lateral-29882
Mastectomy Simple Complete-19303
Cysto W-Simple Removal Stone And Stent-52310
Dstrj Cutaneous Vascular Lesions 10.0-50.0 Sq Cm-17107
Breast Reduction-19318
Strabismus Recession-Rescj 2 Hrzntl Musc-67312
Insj Non-Biodegradable Drug Delivery Implant-11981
Surgical Arthroscopy Shoulder Capsulorrhaphy-29806
Tendon Sheath Incision-26055
Brnchsc W-Brncl Alveolar Lavage-31624
Tympanoplasty W-O Mastoidect W-O Ossicle Recnstj-69631
Destruction Cutaneous Vasc Proliferative Less Than 10Cm-17106
Chemodenervation One Extremity 1-4 Muscle-64642
Arthroscopy Hip W-Labral Repair-29916
Probe Nasolacrimal Duct W-Wo Irrig Req Gen Anes-68811
Ventilating Tube Rmvl Requiring General Anes-69424
Arthroscopy Knee W-Lysis Adhesions W-Wo Manj Spx-29884
Laparoscopy Surg Rpr Initial Inguinal Hernia-49650
Meatotomy Cutting Meatus Spx Except Infant-53020
Mastectomy Gynecomastia-19300
Diagnostic Lumbar Spinal Puncture-62270
Chemodenervation 1 Extremity 5 Or More Muscles-64644
Closed Treatment Nasal Fracture W-Stabilization-21320
Exc B9 Les Mrgn Xcp Sk Tg F-E-E-N-L-M 0.6-1.0Cm-11441
Brnchsc Incl Fluor Gdnce Dx W-Cell Washg Spx-31622
Insj Tunneled Ctr Vad W-Subq Port Age 5 Yr-Greater Than-36561
Tonsillectomy Primary-Secondary Age 12-Greater Than-42826
Rpr Umbilical Hrna 5 Yrs-Greater Than Reducible-49585
Penis Straightening Chordee-54300
Cochlear Device Implantation W-Wo Mastoidectomy-69930
Exc B9 Les Mrgn Xcp Sk Tg F-E-E-N-L-M 1.1-2.0Cm-11442
Injection Single-Mlt Trigger Point 1-2 Muscles-20552
Prq Skel Fixj Phlngl Shft Fx Prox-Middle Px-F-T-26727
Tenotomy Prq Achilles Tendon Spx Local Anes-27605
Lngth-Shrt Tendon Leg-Ankle 1 Tendon Spx-27685
Arthrs Knee Drlg Osteochond Dissecans Int Fixj-29887
Dilation Vagina W-Anesthesia Other Than Local-57400
Insertion Intrauterine Device Iud-58300
Injection Aaand-Strd Other Peripheral Nerve-Branch-64450
Aspiration And Injection Treatment Bone Cyst-20615
Arthrs Knee Drilling Osteochond Dissecans Lesion-29886
Njx Dx-Ther Agt Pvrt Facet Jt Lmbr-Sac 1 Level-64493
Open Tx Radialandulnar Shaft Fx W-Fixj Radiusandulna-25575
Arrst Hemiepiphysl Dstl Femur-Prox Tibia-Fibula-27485
Arthrs Knee Abrasion Arthrp-Mlt Drlg-Microfx-29879
Exc Xtrparenchymal Lesion Testis-54512
Arrest Epiphyseal Distal Femur-27475
Egd Flexible Foreign Body Removal-43247
Orchiectomy Simple Scrotal-Inguinal Approach-54520
Adjt Tis Trns-Reargmt F-C-C-M-N-A-G-H-F 10Sqcm-Less Than-14040
Open Treatment Humeral Condylar Fracture-24579
Sigmoidoscopy Flx W-Biopsy Single-Multiple-45331
1 Stg Dstl Hypospadias Rpr W-Urtp Skin Flaps-54324
1 Stg Dstl Hypospadias Rpr Urtp Skn Flaps-54326
Intravitreal Njx Pharmacologic Agt Spx-67028
Treatment Extensive Retinopathy Photocoagulation-67228
Chemodenervation Extraocular Muscle-67345
Exc B9 Lesion Mrgn Xcp Sk Tg T-A-L Greater Than 4.0 Cm-11406
Graft Ear Crtlg Autogenous Nose-Ear-21235
Open Tx Humeral Epicondylar Fracture-24575
Excision Ganglion Wrist Dorsal-Volar Primary-25111
Ligamentous Reconstruction Knee Extra-Articular-27427
Submucous Rescj Inferior Turbinate Prtl-Compl-30140
Rmvl Tun Ctr Vad W-Subq Port-Pmp Ctr-Prph Insj-36590
Cystourethroscopy-52000
Lysis-Excision Penile Postcircumcision Adhesions-54162
Rdctj Torsion Tstis W-Wo Fixj Clat Testis-54600
Prtl Hymenectomy-Revj Hymenal Ring-56700
Exc Chalazion Anes Req Hospization Single-Mult-67808
Exc B9 Lesion Mrgn Xcp Sk Tg S-N-H-F-G 0.6-1.0Cm-11421
Repair Intermediate S-A-T-E 2.6-7.5 Cm-12032
Repair Complex F-C-C-M-N-Ax-G-H-F 1.1-2.5 Cm-13131
Reconstruction Toe Polydactyly-28344
Arthroscopy Hip W-Femoroplasty-29914
Septoplasty-Submucous Resecj W-Wo Cartilage Grf-30520
Nasal Endoscopy Diagnostic Uni-Bi Spx-31231
Laryngoscopy Flx-Rgd Telescopic W-Stroboscopy-31579
Bx-Exc Lymph Node Open Deep Cervical Node-38510
Incision Lingual Frenum Frenotomy-41010
Tonsillectomy And Adenoidectomy Age 12-Greater Than-42821
Adenoidectomy Primary Age 12-Greater Than-42831
Closure Gastrostomy Surg-43870
Rpr Umbilical Hernia Less Than 5 Yrs Reducible-49580
Rmvl Fb Xtrnl Auditory Canal Anes-69205
Myringoplasty-69620
Otolaryngologic Exam Under General Anesthesia-92502
Rmvl W-Rinsj Non-Biodegradable Drug Dlvr Implt-11983
Repair Intermediate S-A-T-E 2.5 Cm-Less Than-12031
Adjt Tis Trnsfr-Rearrgmt E-N-E-L Dfct 10 Sq Cm-Less Than-14060
Removal Sutures Under Anesthesia Same Surgeon-15850
Reinsertion Spinal Fixation Device-22849
Open Tx Clavicular Fracture Internal Fixation-23515
Prq Skel Fixj Humrl Cndylr Fx Medial-Lat W-Manj-24582
Rcnstj Polydactylous Digit Soft Tissue And Bone-26587
Prq Skeletal Fixj Metacarpal Fx Each Bone-26608
Excision-Curettage Cyst-Tumor Femur-27355
Open Treatment Fracture Distal Tibia Only-27827
Ostectomy Tarsal Coalition-28116
Arthroscopy Aid Tx Spineand-Fx Knee W-Fixj-29851
Esophagoscopy Rig Transoral Removal Foreign Body-43194
Foreskn Manj W-Lss Preputial Adsandstretching-54450
Laparoscopy W-Rmvl Adnexal Structures-58661
Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl-Thora-64633
Chemodenervation 1 Extremity Ea Addl 1-4 Muscle-64643
Orbitotomy W-O Bone Flap W-Removal Lesion-67412
Tympanoplasty W-O Mastoidec 1St-Revj Prosth Torp-69633
Collagen Cross-Linking Of Cornea Med Separate-0402T
Exc B9 Les Mrgn Xcp Sk Tg F-E-E-N-L-M 2.1-3.0Cm-11443
Exc B9 Les Mrgn Xcp Sk Tg F-E-E-N-L-M 3.1-4.0Cm-11444
Repair Intermediate F-E-E-N-Land-Muc 2.5 Cm-Less Than-12051
Grafting Of Autologous Soft Tiss By Direct Exc-15769
Injection Single-Mlt Trigger Point 3-Greater Than Muscles-20553
Osteochondral Autograft Knee Open Mosaicplasty-27416
Open Treatment Bimalleolar Ankle Fracture-27814
Penis Corrj Chordee-1St Stage Hypospadias Rpr-54304
Incision And Drainage Abscess Simple-Single-10060
Exc B9 Lesion Mrgn Xcp Sk Tg F-E-E-N-L-M 0.5Cm-Less Than-11440
Removal Non-Biodegradable Drug Delivery Implant-11982
Repair Intermediate F-E-E-N-Land-Muc 2.6-5.0 Cm-12052
Excision Tumor Soft Tiss Face-Scalp Subq Less Than 2Cm-21011
Open Treatment Radial Shaft Fracture-25515
Perq Skel Fixj Distal Radial Fx-Epiphysl Sep-25606
Open Tx Carpal Scaphoid Navicular Fracture-25628
Excision-Curettage Cyst-Tumor Phalanx Finger-26210
Rpr Coltrl Ligm Mtcarphlngl-Iphal Jt-26540
Excision Tumor Soft Tissue Thigh-Knee Subq Less Than 3Cm-27327
Arrest Epiphyseal Tibia And Fibula Proximal-27477
Arrst Epiphysl Cmbn Dstl Femur Prox Tibfib-27479
Optx Patllr Fx W-Int Fixj-Patllcandsoft Tiss Rpr-27524
Optx Patellar Dislc W-Wo Prtl-Tot Patellectomy-27566
Excision-Curettage Bone Cyst-Tumor Tibia-Fibula-27635
Lngth-Shrt Tdn Leg-Ankle Mlt Tdn Same Inc Ea-27686
Gastrocnemius Recession-27687
Repair Secondary Disrupted Ligament Ankle Coltrl-27698
Rcnstj Pst Tibl Tdn W-Exc Accessory Tarsl Navclr-28238
Arthroscopy Aid Tx Spineand-Fx Knee W-O Fixj-29850
Nasal-Sinus Ndsc Surg W-Control Nasal Hemrrg-31238
Largsc W-Njx Vocal Cord Ther W-Micro-Telescope-31571
Insj Tunneled Ctr Vad W-Subq Port Under 5 Yr-36560
Esophagogastroduodenoscopy Submucosal Injection-43236
Rpr 1St Ingun Hrna Full Term Inft Less Than 6 Mo Rdc-49495
Cysto W-Insert Ureteral Stent-52332
Cysto-Uretero W-Lithotripsy Andindwell Stent Insrt-52356
Circumcision W-Clamp-Oth Dev W-Block-54150
Orchiectomy Partial-54522
Excision Hydrocele Unilateral-55040
Injection Aaand-Strd Nerves Nrvtg Si Joint W-Img-64451
Chemodenervation Muscle Neck Unilat For Dystonia-64616
Rmvl Lens Material Intracapsular-66920
Vitrectomy Mechanical Pars Plana-67036
Dstrj Loclzd Lesion Retina 1-Greater Than Sess Pc-67210
Excision Chalazion Single-67800
Rpr Blepharoptosis Levator Rescj-Advmnt Xtrnl-67904
Exc B9 Lesion Mrgn Xcp Sk Tg T-A-L 0.5 Cm-Less Than-11400
Exc B9 Lesion Mrgn Xcp Sk Tg T-A-L 1.1-2.0 Cm-11402
Exc B9 Lesion Mrgn Xcp Sk Tg S-N-H-F-G 1.1-2.0Cm-11422
Exc B9 Lesion Mrgn Xcp Sk Tg S-N-H-F-G Greater Than 4.0Cm-11426
Adjt-Reargmt F-C-C-M-N-Ax-G-H-F 10.1-30.0 Sq Cm-14041
Breast Augmentation With Implant-19325
Biopsy Muscle Deep-20205
Removal Implant Superficial Separate Procedure-20670
Removal External Fixation System Under Anes-20694
Closed Tx Nasal Fracture W-O Stabilization-21315
Arthrt Elbow W-Jnt Expl W-Wobx W-Wormvl Loose-Fb-24101
Closed Tx Monteggia Fx Dislocation Elbow W-Manj-24620
Open Tx Radial Head-Neck Fracture-24665
Epiphysl Arrst Epiphysiod-Stapling Dstl Rds-U-25450
Open Tx Metacarpal Fracture Single Ea Bone-26615
Open Tx Phalangeal Shaft Fracture Prox-Middle Ea-26735
Osteochondral Allograft Knee Open-27415
Ligamentous Reconstruction Knee Intra-Articular-27428
Tenotomy Prq Achilles Tendon Spx General Anes-27606
Exc-Curettage Cyst-Tumor Tibia-Fibula W-Algraft-27638
Osteotomy Calcaneus W-Wo Internal Fixation-28300
Arthroscopy Hip Surgical W-Removal Loose-Fb-29861
Arthroscopy Knee Lateral Release-29873
Arthroscopy Knee Synovectomy 2-Greater Than Compartments-29876
Arthrs Knee Debridement-Shaving Artclr Crtlg-29877
Arthroscopy Hip W-Acetabuloplasty-29915
Excision Inferior Turbinate Partial-Complete-30130
Control Nasal Hemorrhage Anterior Simple-30901
Nasal-Sinus Ndsc Surg W-Dacryocstorhinostomy-31239
Rmvl Tun Cvc W-O Subq Port-Pmp-36589
Exc Branchial Cleft Cyst Confined Sknandsubq Tis-42810
Tonsillectomy Primary-Secondary Less Than Age 12-42825
Bx Anorectal Wall Anal Approach-45100
Perirectal Inj Sclerosing Solution Prolapse-45520
Anrct Xm Surg Req Anes General Spi-Edrl Dx-45990
Chemodenervation Internal Anal Sphincter-46505
Laps Abd Prtmandomentum Dx W-Wo Spec Br-Wa Spx-49320
Laps Surg W-Aspir Cavity-Cyst Single-Multiple-49322
Aspiration Bladder Insert Suprapubic Catheter-51102
Urethromeatoplasty W-Mucosal Advancement-53450
Frenulotomy Penis-54164
Laparoscopy Orchiopexy Intra-Abdominal Testis-54692
Lysis Labial Adhesions-56441
Colposcopy Entire Vagina W-Cervix If Present-57420
Craniectomy W-Excision Tumor-Lesion Skull-61500
Injection Aaand-Strd Greater Occipital Nerve-64405
Injection Aaand-Strd Ilioinguinal Ih Nerves-64425
Chemodnrvtj Musc Musc Innervated Facial Nrv Unil-64612
Xcapsl Ctrc Rmvl Insj Io Lens Prosth Cplx Wo Ecp-66982
Icapsular Cataract Xtrj Insj Io Lens Prsth 1 Stg-66983
Exc Lesion Eyelid W-O Clsr-W-Simple Dir Closure-67840
Removal Impacted Cerumen Instrumentation Unilat-69210
Otoplasty Protruding Ear W-Wo Size Rdctj-69300
Ther Proph-Dx Njx Iv Push Single-1St Sbst-Drug-96374
Insertion Of Sinus Tarsi Implant-0335T
Incision And Removal Foreign Body Subq Tiss Simple-10120
Removal Skn Tags Mlt Fibrq Tags Any Area Upw-15-11200
Excision Nail Matrix Permanent Removal-11750
Injection Intralesional Up To And Includ 7 Lesions-11900
Repair Intermediate N-H-F-Xtrnl Gent 2.5Cm-Less Than-12041
Repair Complex Scalp-Arm-Leg 1.1-2.5 Cm-13120
Repair Complex Eyelid-Nose-Ear-Lip 2.6-7.5 Cm-13152
Adjnt Tis Transfr-Rearrange Trunk 10.1-30.0 Sqcm-14001
Select the procedure in question.
Insurance Name
De-identified Minimum
De-identified Maximum
Discounted Cash Price
Blue Cross All Products IP
Blue Cross HMO/POS LW OP
Blue Cross All Product FS SAT OP
Blue Cross PPO LW OP
Blue Cross Indem OP
Harvard Pilgrim All Products IP
Harvard Pilgrim LOC LW FOC OP
Harvard Pilgrim LOC NAT FOC SAT OP
Harvard Pilgrim NAT LW OP
Harvard Pilgrim SCOAST LW OP
Harvard Pilgrim SCOAST SAT OP
Tufts HMO POS PPO IP
Tufts CARELINK IP
Tufts HMO OP
Tufts POS PPO OP
Tufts CARELINK OP
Aetna COMM IP OP
Cigna IP
Cigna OP
United COMM IP OP
Tufts Public Plan COMM QHP IP
Tufts Public Plan COMM QHP OP
Allways HMO QHP IP
Allways HMO QHP OP
Allways PPO IP
Allways PPO OP
Coventry HCVM IP OP
Fallon COMM IP
Fallon COMM OP
Humana IP OP
Multiplan Clients IP OP
PHCS Clients IP OP
Unicare GIC IP
Unicare GIC OP
Beacon BMCHP (QHP) IP OP
Beacon BMC (NH products) IP OP
Beacon FCHP COMM IP OP
Beacon GIC (Certain Products) IP OP
Cigna Behavioral IP
United Behavioral (Optum) IP
Cigna Behavioral OP
United Behavioral (Optum) OP
Aetna Transplants IP
Aetna Transplants OP
Cigna Lifesource IP
Cigna Lifesource OP
Interlink Transplant IP
Interlink Transplant OP
LifeTrac IP
LifeTrac OP
Optum/URN COMM IP
Optum/URN COMM OP
Optum/URN COMM CHD ONC OP
Select your Insurance Plan.
Co-Insurance (%)
Please enter the percentage value of your co-insurance (when applicable).
Insurance average allowable amount
The estimated average dollar amount allowed by your insurance.
Patient Self-Pay Estimated Amount
The estimated dollar amount you may be responsable for.