| Arthrocentesis (outpatient) | $1,264 | 0% | $1,264 | 
Medium |
| Biopsy - Breast | $3,357 | 0% | $3,357 |
Medium |
| Biopsy - Endometrial (Uterus) | $814 | 0% | $814 |
Medium |
| Blood Test - Basic Metabolic Panel | $28 | 0% | $28 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $30 | 0% | $30 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $77 | 0% | $77 |
Medium |
| Blood Test - Clotting Time | $15 | 0% | $15 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $46 | 0% | $46 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $35 | 0% | $35 |
Medium |
| Blood Test - Electrolytes Panel | $43 | 0% | $43 |
Medium |
| Blood Test - General Health Panel | $186 | 0% | $186 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $61 | 0% | $61 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $433 | 0% | $433 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $106 | 0% | $106 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $89 | 0% | $89 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $105 | 0% | $105 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $57 | 0% | $57 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $53 | 0% | $53 |
Medium |
| Blood Test - Vitamin D-3 Level | $141 | 0% | $141 |
Medium |
| Bone Density Scan (outpatient) | $421 | 0% | $421 |
Medium |
| Chiropractic Manipulative Treatment - Spinal, 3-4 Regions | $53 | 0% | $53 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,194 | 0% | $4,194 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,206 | 0% | $5,206 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,162 | 0% | $5,162 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,018 | 0% | $2,018 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,642 | 0% | $1,642 | 
Low |
| CT Scan - Head/Brain, without Contrast | $805 | 0% | $805 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $203 | 0% | $203 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $189 | 0% | $189 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $300 | 0% | $300 |
Medium |
| Fetal Non-Stress Test | $669 | 0% | $669 |
Medium |
| Mammogram (outpatient) | $729 | 0% | $729 |
Medium |
| Myocardial Imaging (outpatient) | $5,489 | 0% | $5,489 |
Medium |
| Office Visit - Basic | $139 | 0% | $139 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $361 | 0% | $361 |
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, 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 - Established Patient, High Complexity | $441 | 0% | $441 |
Medium |
| Office Visit - Established Patient, Low Complexity | $210 | 0% | $210 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $310 | 0% | $310 |
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 - High Complexity Evaluation | $267 | 0% | $267 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $267 | 0% | $267 |
Medium |
| Physical Therapy - Manual Therapy | $107 | 0% | $107 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $267 | 0% | $267 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $42 | 0% | $42 |
Medium |
| Physical Therapy - Therapeutic Activities | $126 | 0% | $126 |
Medium |
| Physical Therapy - Therapeutic Exercises | $116 | 0% | $116 |
Medium |
| Physical Therapy - Ultrasound Therapy | $45 | 0% | $45 |
Medium |
| Psychiatric Diagnostic Evaluation | $179 | 0% | $179 |
Medium |
| Psychotherapy - 45 Minutes | $147 | 0% | $147 |
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 | $655 | 0% | $655 |
Medium |
| Ultrasound - Abdominal, Limited | $498 | 0% | $498 |
Medium |
| Ultrasound - Breast (outpatient) | $659 | 0% | $659 | 
High |
| Ultrasound - Head and Neck | $482 | 0% | $482 |
Medium |
| Ultrasound - Pelvic (outpatient) | $757 | 0% | $757 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $644 | 0% | $644 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $582 | 0% | $582 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $839 | 0% | $839 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,297 | 0% | $4,297 |
Medium |
| Urine Test - Automated with Microscope Examination | $58 | 0% | $58 |
Medium |
| Urine Test - Automated without Microscope | $23 | 0% | $23 |
Medium |
| Urine Test - Bacterial Culture | $28 | 0% | $28 |
Medium |
| Urine Test - Chlamydia | $40 | 0% | $40 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $87 | 0% | $87 |
Medium |
| Urine Test - Pregnancy | $25 | 0% | $25 |
Medium |
| X-Ray - Abdomen | $446 | 0% | $446 |
Medium |
| X-Ray - Chest (outpatient) | $550 | 0% | $550 |
Medium |
| X-Ray - Foot (outpatient) | $485 | 0% | $485 |
Medium |
| X-Ray - Hand | $555 | 0% | $555 |
Medium |
| X-Ray - Hip | $544 | 0% | $544 |
Medium |
| X-Ray - Knee (outpatient) | $584 | 0% | $584 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $965 | 0% | $965 |
Medium |
| X-Ray - Shoulder (outpatient) | $488 | 0% | $488 |
Medium |
| X-Ray - Spine (outpatient) | $733 | 0% | $733 |
Medium |
| X-Ray - Wrist (outpatient) | $506 | 0% | $506 |
Medium |
