| Arthrocentesis (outpatient) | $1,005 | 0% | $1,005 | 
Medium |
| Bacterial Culture Swab | $46 | 0% | $46 |
Medium |
| Biopsy - Breast | $3,519 | 0% | $3,519 |
Medium |
| Biopsy - Endometrial (Uterus) | $977 | 0% | $977 |
Medium |
| Blood Test - Basic Metabolic Panel | $30 | 0% | $30 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $34 | 0% | $34 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $82 | 0% | $82 |
Medium |
| Blood Test - Clotting Time | $17 | 0% | $17 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $49 | 0% | $49 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $37 | 0% | $37 |
Medium |
| Blood Test - Electrolytes Panel | $47 | 0% | $47 |
Medium |
| Blood Test - Folic Acid Level | $103 | 0% | $103 |
Medium |
| Blood Test - General Health Panel | $198 | 0% | $198 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $65 | 0% | $65 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $76 | 0% | $76 |
Medium |
| Blood Test - LDL Cholesterol Level | $55 | 0% | $55 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $22 | 0% | $22 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $114 | 0% | $114 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $62 | 0% | $62 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $57 | 0% | $57 |
Medium |
| Blood Test - Vitamin D-3 Level | $151 | 0% | $151 |
Medium |
| Bone Density Scan (outpatient) | $421 | 0% | $421 |
Medium |
| Chiropractic Manipulative Treatment - Spinal, 3-4 Regions | $53 | 0% | $53 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,411 | 0% | $4,411 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,353 | 0% | $5,353 | 
High |
| Colonoscopy - With Polyp Removal (outpatient) | $5,274 | 0% | $5,274 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,076 | 0% | $2,076 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,697 | 0% | $1,697 |
Medium |
| CT Scan - Head/Brain, without Contrast | $852 | 0% | $852 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $219 | 0% | $219 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $197 | 0% | $197 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $300 | 0% | $300 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $39 | 0% | $39 |
Medium |
| Fetal Non-Stress Test | $754 | 0% | $754 |
Medium |
| Gall Bladder Surgery (outpatient) | $13,097 | 0% | $13,097 |
Medium |
| Mammogram (outpatient) | $767 | 0% | $767 |
Medium |
| Office Visit - Basic | $139 | 0% | $139 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $365 | 0% | $365 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $424 | 0% | $424 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $284 | 0% | $284 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $310 | 0% | $310 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $341 | 0% | $341 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $370 | 0% | $370 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $284 | 0% | $284 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $273 | 0% | $273 |
Medium |
| Office Visit - Established Patient, High Complexity | $441 | 0% | $441 |
Medium |
| Office Visit - Established Patient, Low Complexity | $223 | 0% | $223 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $333 | 0% | $333 |
Medium |
| Office Visit - New Patient, Low Complexity | $305 | 0% | $305 |
Medium |
| Pap Test | $84 | 0% | $84 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $33 | 0% | $33 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $289 | 0% | $289 |
Medium |
| Physical Therapy - Manual Therapy | $116 | 0% | $116 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $289 | 0% | $289 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $42 | 0% | $42 |
Medium |
| Physical Therapy - Therapeutic Activities | $131 | 0% | $131 |
Medium |
| Physical Therapy - Therapeutic Exercises | $124 | 0% | $124 |
Medium |
| Physical Therapy - Ultrasound Therapy | $49 | 0% | $49 |
Medium |
| Strep Test (Streptococcus, group A) | $41 | 0% | $41 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $41 | 0% | $41 |
Medium |
| Ultrasound - Abdominal, Complete | $697 | 0% | $697 |
Medium |
| Ultrasound - Abdominal, Limited | $528 | 0% | $528 |
Medium |
| Ultrasound - Breast (outpatient) | $678 | 0% | $678 |
High |
| Ultrasound - Head and Neck | $511 | 0% | $511 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $644 | 0% | $644 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $648 | 0% | $648 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $741 | 0% | $741 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,429 | 0% | $4,429 |
Medium |
| Urine Capacity Measurement | $747 | 0% | $747 |
High |
| Urine Test - Automated with Microscope Examination | $33 | 0% | $33 |
Medium |
| Urine Test - Automated without Microscope | $25 | 0% | $25 |
Medium |
| Urine Test - Bacterial Culture | $50 | 0% | $50 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $32 | 0% | $32 |
Medium |
| Urine Test - Chlamydia | $83 | 0% | $83 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $95 | 0% | $95 |
Medium |
| Urine Test - Pregnancy | $27 | 0% | $27 |
Medium |
| X-Ray - Abdomen | $423 | 0% | $423 |
Medium |
| X-Ray - Ankle (outpatient) | $505 | 0% | $505 |
High |
| X-Ray - Chest (outpatient) | $570 | 0% | $570 |
Medium |
| X-Ray - Foot (outpatient) | $499 | 0% | $499 |
Medium |
| X-Ray - Hand | $580 | 0% | $580 |
Medium |
| X-Ray - Hip | $613 | 0% | $613 |
Medium |
| X-Ray - Knee (outpatient) | $525 | 0% | $525 |
High |
| X-Ray - Middle Back, Thoracic Spine | $707 | 0% | $707 |
Medium |
| X-Ray - Shoulder (outpatient) | $559 | 0% | $559 |
Medium |
| X-Ray - Spine (outpatient) | $760 | 0% | $760 |
Medium |
| X-Ray - Wrist (outpatient) | $489 | 0% | $489 |
Medium |
