| Arthrocentesis (outpatient) | $632 | 0% | $632 | 
Medium |
| Bacterial Culture Swab | $187 | 0% | $187 |
Medium |
| Biopsy - Skin Lesion | $1,516 | 0% | $1,516 |
Medium |
| Blood Test - Basic Metabolic Panel | $161 | 0% | $161 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $109 | 0% | $109 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $150 | 0% | $150 |
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 | $105 | 0% | $105 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $60 | 0% | $60 |
Medium |
| Blood Test - Folic Acid Level | $125 | 0% | $125 |
Medium |
| Blood Test - General Health Panel | $225 | 0% | $225 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $54 | 0% | $54 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $131 | 0% | $131 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $80 | 0% | $80 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $95 | 0% | $95 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $140 | 0% | $140 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $142 | 0% | $142 |
Medium |
| Blood Test - Vitamin D-3 Level | $203 | 0% | $203 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,524 | 0% | $2,524 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,256 | 0% | $3,256 |
Medium |
| Destruction of Lesion (outpatient) | $604 | 0% | $604 |
Medium |
| Destruction of Lesions, up to 14 | $655 | 0% | $655 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $345 | 0% | $345 |
Medium |
| Electrocardiogram (ECG or EKG) | $726 | 0% | $726 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $149 | 0% | $149 |
Medium |
| Laryngoscopy - Diagnostic | $1,493 | 0% | $1,493 |
Medium |
| Mammogram (outpatient) | $947 | 0% | $947 |
Medium |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,326 | 0% | $1,326 | 
High |
| Office Visit - Basic | $147 | 0% | $147 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $377 | 0% | $377 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $442 | 0% | $442 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $442 | 0% | $442 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $489 | 0% | $489 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $407 | 0% | $407 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $357 | 0% | $357 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $310 | 0% | $310 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $239 | 0% | $239 |
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 | $310 | 0% | $310 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $273 | 0% | $273 |
Medium |
| Office Visit - Established Patient, High Complexity | $482 | 0% | $482 |
Medium |
| Office Visit - Established Patient, Low Complexity | $173 | 0% | $173 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $267 | 0% | $267 |
Medium |
| Office Visit - New Patient, Low Complexity | $236 | 0% | $236 |
Medium |
| Office Visit - New Patient, Minor | $177 | 0% | $177 |
Medium |
| Pap Test | $225 | 0% | $225 |
Medium |
| Physical Therapy - Therapeutic Exercises | $138 | 0% | $138 |
Medium |
| Psychiatric Diagnostic Evaluation | $193 | 0% | $193 |
Medium |
| Psychotherapy - 30 Minutes | $161 | 0% | $161 |
Medium |
| Psychotherapy - Group Session | $129 | 0% | $129 |
Medium |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $105 | 0% | $105 |
Medium |
| Ultrasound - Breast (outpatient) | $552 | 0% | $552 |
High |
| Urine Capacity Measurement | $507 | 0% | $507 |
Medium |
| Urine Test - Automated with Microscope Examination | $38 | 0% | $38 |
Medium |
| Urine Test - Automated without Microscope | $56 | 0% | $56 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $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) | $581 | 0% | $581 |
Medium |
| X-Ray - Knee (outpatient) | $856 | 0% | $856 |
Medium |
