Treatment of missed abortion, completed surgically
up to $2218*
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
up to $2053*
Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C
up to $4720*
Marsupialization of Bartholin's gland cyst
up to $795*
Endometrial biopsy
up to $1359*
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
up to $6465*
Abdominal myomectomy, removal of fibroids through abdominal incision
up to $3157*
Colpopexy, vaginal
up to $2326*
Cryosurgery of the penis
up to $602*
Treatment of ectopic pregnancy with salpingostomy
up to $2791*
Colpopexy, abdominal approach
up to $3234*
Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)
up to $2314*
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less
up to $1805*
Laparoscopic treatment of ectopic pregnancy
up to $2728*
Endometrial ablation, thermal
up to $3298*
Loop electrosurgical excision procedure (LEEP)
up to $1467*
Colpopexy, vaginal approach
up to $2348*
Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)
up to $7535*
Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g
up to $14057*
Induced abortion by dilation and curettage
up to $1289*
Destruction of anal warts by electrocautery
up to $2509*
Ovarian cystectomy, unilateral or bilateral
up to $2602*
Incision and drainage of Bartholin's gland abscess
up to $756*
New patient preventive medicine evaluation for individuals aged 18-39 years
up to $386*
Cervical biopsy
up to $534*
Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
up to $6557*
Treatment of incomplete abortion, any trimester, completed surgically
up to $1828*
Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)
up to $950*
Hysteroscopy, diagnostic (separate procedure)
up to $1346*
Tubal ligation reversal, microsurgical technique
up to $3068*
Anterior and/or posterior colporrhaphy
up to $1191*
Laparoscopic vaginal hysterectomy, with removal of tubes and/or ovaries
up to $3292*
Chromotubation of oviduct, including materials
up to $698*
Laparoscopic colpopexy
up to $3254*
Unlisted procedure, female genital system (nonobstetrical)
up to $98*
Mastectomy for gynecomastia
up to $2402*
Vulvar biopsy, single lesion
up to $404*
Human chorionic gonadotropin (hCG) quantitative test
up to $13*
Dilation and curettage, diagnostic and/or therapeutic
up to $1371*
Hysteroscopy, surgical; with removal of leiomyomata and/or polyps
up to $1495*
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic
up to $2378*
Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)
up to $1707*
Clitoroplasty for intersex state
up to $10150*
Cytopathology, cervical or vaginal
up to $43*
Laparoscopic myomectomy, removal of very large or multiple fibroids
up to $3744*
Oophorectomy, partial or total, unilateral or bilateral
up to $1894*
Vaginal hysterectomy, for uterus 250 g or less
up to $2824*
Laparoscopic supracervical hysterectomy, with removal of tubes and/or ovaries
up to $6091*
Endocervical curettage
up to $749*
Hysterosalpingography, radiological supervision and interpretation
up to $332*
Embryo transfer, intrauterine
up to $299*
Excision of breast lesion identified by preoperative placement of radiological marker, open
up to $4906*
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus
up to $530*
Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
up to $2716*
Neisseria gonorrhoeae, direct probe technique
up to $40*
Vaginal dilation under anesthesia
up to $230*
Hysterosalpingography
up to $858*
Total abdominal hysterectomy with removal of tubes and/or ovaries
up to $11241*
Hysteroscopy, surgical, with bilateral fallopian tube cannulation
up to $5888*
Labiaplasty, wedge excision
up to $4027*
Routine obstetric (pregnancy) care for vaginal delivery, incl pre- and post- delivery care
up to $16237*
Vaginoplasty for congenital anomaly
up to $5427*
Laparoscopy, surgical, supracervical hysterectomy
up to $2443*
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)
up to $2093*
In vitro fertilization
up to $528*
Laparoscopic myomectomy, removal of fibroids
up to $9835*
Vulvar biopsy, each additional lesion
up to $166*
Hysteroscopy, surgical; with division or resection of intrauterine septum
up to $1044*
Insertion, non-biodegradable drug delivery implant
up to $342*
Mammography, screening, bilateral
up to $429*
Complex cystometrogram with voiding pressure studies
up to $879*
Insertion of mesh or other prosthesis for repair of pelvic floor
up to $830*
Ultrasound, retroperitoneal, limited
up to $193*
HPV vaccine, types 6, 11, 16, 18
up to $229*
Ultrasound guidance for aspiration of ova
up to $265*
Stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s)
up to $2592*
Enterocele repair
up to $2930*
Mammogram, both breasts (not for routine screening)
up to $531*
Automated urinalysis test
up to $4*
Biopsy of breast; percutaneous, needle core, not using imaging guidance
up to $1589*
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