| Arthrocentesis (outpatient) | $344 | 0% | $344 | 
Medium |
| Blood Test - Basic Metabolic Panel | $28 | 0% | $28 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $33 | 0% | $33 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $60 | 0% | $60 |
Medium |
| Blood Test - Clotting Time | $13 | 0% | $13 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $22 | 0% | $22 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | 0% | $26 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $35 | 0% | $35 |
Medium |
| Blood Test - Electrolytes Panel | $23 | 0% | $23 |
Medium |
| Blood Test - Folic Acid Level | $49 | 0% | $49 |
Medium |
| Blood Test - General Health Panel | $104 | 0% | $104 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $27 | 0% | $27 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $52 | 0% | $52 |
Medium |
| Blood Test - LDL Cholesterol Level | $32 | 0% | $32 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $21 | 0% | $21 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | 0% | $61 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $28 | 0% | $28 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $56 | 0% | $56 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $29 | 0% | $29 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | 0% | $49 |
Medium |
| Blood Test - Vitamin D-3 Level | $99 | 0% | $99 |
Medium |
| Destruction of Lesion (outpatient) | $700 | 0% | $700 |
Medium |
| Electrocardiogram (ECG or EKG) | $385 | 0% | $385 |
Medium |
| Laryngoscopy - Diagnostic | $602 | 0% | $602 |
Medium |
| Mammogram (outpatient) | $916 | 0% | $916 |
Medium |
| MRI - Back (outpatient) | $3,996 | 0% | $3,996 |
Medium |
| Nasal Endoscopy - Diagnostic | $801 | 0% | $801 |
Medium |
| Office Visit - Basic | $109 | 0% | $109 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $279 | 0% | $279 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $330 | 0% | $330 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $318 | 0% | $318 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $370 | 0% | $370 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $291 | 0% | $291 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $267 | 0% | $267 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $261 | 0% | $261 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $287 | 0% | $287 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $292 | 0% | $292 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $312 | 0% | $312 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $260 | 0% | $260 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $245 | 0% | $245 |
Medium |
| Office Visit - Established Patient, High Complexity | $361 | 0% | $361 |
Medium |
| Office Visit - Established Patient, Low Complexity | $171 | 0% | $171 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $268 | 0% | $268 |
Medium |
| Office Visit - New Patient, Low Complexity | $270 | 0% | $270 |
Medium |
| Office Visit - New Patient, Minor | $177 | 0% | $177 |
Medium |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 0% | $53 |
Medium |
| Physical Therapy - Application of Mechanical Traction | $53 | 0% | $53 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $53 | 0% | $53 |
Medium |
| Physical Therapy - High Complexity Evaluation | $210 | 0% | $210 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $252 | 0% | $252 |
Medium |
| Physical Therapy - Manual Therapy | $74 | 0% | $74 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $210 | 0% | $210 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $89 | 0% | $89 |
Medium |
| Physical Therapy - Re-Evaluation | $95 | 0% | $95 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $79 | 0% | $79 |
Medium |
| Physical Therapy - Therapeutic Activities | $79 | 0% | $79 |
Medium |
| Physical Therapy - Therapeutic Exercises | $91 | 0% | $91 |
Medium |
| Physical Therapy - Ultrasound Therapy | $68 | 0% | $68 |
Medium |
| Strep Test (Streptococcus, group A) | $40 | 0% | $40 |
Medium |
| Urine Capacity Measurement | $421 | 0% | $421 |
Medium |
| Urine Test - Automated with Microscope Examination | $11 | 0% | $11 |
Medium |
| Urine Test - Automated without Microscope | $7 | 0% | $7 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $41 | 0% | $41 |
Medium |
| Urine Test - Chlamydia | $117 | 0% | $117 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $117 | 0% | $117 |
Medium |
| Urine Test - Pregnancy | $21 | 0% | $21 |
Medium |
| X-Ray - Ankle (outpatient) | $397 | 0% | $397 |
Medium |
| X-Ray - Foot (outpatient) | $296 | 0% | $296 |
Medium |
| X-Ray - Hand | $444 | 0% | $444 |
Medium |
| X-Ray - Hip | $303 | 0% | $303 |
Medium |
| X-Ray - Knee (outpatient) | $394 | 0% | $394 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $463 | 0% | $463 |
Medium |
| X-Ray - Shoulder (outpatient) | $385 | 0% | $385 |
Medium |
| X-Ray - Spine (outpatient) | $508 | 0% | $508 |
Medium |
| X-Ray - Wrist (outpatient) | $354 | 0% | $354 |
Medium |
