| Arthrocentesis (outpatient) | $626 | 0% | $626 | 
Medium |
| Biopsy - Skin Lesion | $1,494 | 0% | $1,494 | 
High |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $109 | 0% | $109 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $149 | 0% | $149 |
Medium |
| Blood Test - Clotting Time | $12 | 0% | $12 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $97 | 0% | $97 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $99 | 0% | $99 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $130 | 0% | $130 |
Medium |
| Blood Test - General Health Panel | $225 | 0% | $225 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $54 | 0% | $54 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $105 | 0% | $105 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $95 | 0% | $95 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $125 | 0% | $125 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $141 | 0% | $141 |
Medium |
| Blood Test - Vitamin D-3 Level | $191 | 0% | $191 |
Medium |
| Bone Density Scan (outpatient) | $626 | 0% | $626 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,518 | 0% | $2,518 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,234 | 0% | $2,234 |
Medium |
| Destruction of Lesion (outpatient) | $596 | 0% | $596 |
High |
| Destruction of Lesions, up to 14 | $597 | 0% | $597 |
Medium |
| Laryngoscopy - Diagnostic | $1,257 | 0% | $1,257 |
Medium |
| Mammogram (outpatient) | $854 | 0% | $854 |
Medium |
| MRI - Knee (outpatient) | $3,024 | 0% | $3,024 |
Medium |
| MRI - Pelvis (outpatient) | $7,242 | 0% | $7,242 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,259 | 0% | $1,259 |
Medium |
| Office Visit - Basic | $147 | 0% | $147 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $368 | 0% | $368 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $288 | 0% | $288 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $332 | 0% | $332 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $386 | 0% | $386 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $348 | 0% | $348 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $336 | 0% | $336 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $368 | 0% | $368 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $368 | 0% | $368 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $401 | 0% | $401 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $336 | 0% | $336 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $289 | 0% | $289 |
Medium |
| Office Visit - Established Patient, High Complexity | $450 | 0% | $450 |
Medium |
| Office Visit - Established Patient, Low Complexity | $206 | 0% | $206 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $312 | 0% | $312 |
Medium |
| Office Visit - New Patient, Low Complexity | $191 | 0% | $191 |
Medium |
| Office Visit - New Patient, Minor | $240 | 0% | $240 |
Medium |
| Pap Test | $225 | 0% | $225 |
Medium |
| Psychiatric Diagnostic Evaluation | $151 | 0% | $151 |
Medium |
| Psychotherapy - 30 Minutes | $152 | 0% | $152 |
Medium |
| Psychotherapy - Group Session | $123 | 0% | $123 |
Medium |
| Strep Test (Streptococcus, group A) | $98 | 0% | $98 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $105 | 0% | $105 |
Medium |
| Ultrasound - Breast (outpatient) | $544 | 0% | $544 |
High |
| Ultrasound - Pregnancy (outpatient) | $979 | 0% | $979 |
Medium |
| Urine Capacity Measurement | $429 | 0% | $429 |
Medium |
| Urine Test - Automated with Microscope Examination | $38 | 0% | $38 |
Medium |
| Urine Test - Automated without Microscope | $55 | 0% | $55 |
Medium |
| Urine Test - Bacterial Culture | $107 | 0% | $107 |
Medium |
| Urine Test - Chlamydia | $211 | 0% | $211 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $196 | 0% | $196 |
Medium |
| Urine Test - Pregnancy | $59 | 0% | $59 |
Medium |
| X-Ray - Chest (outpatient) | $550 | 0% | $550 |
Medium |
