| Arthrocentesis (outpatient) | $834 | 0% | $834 | 
Medium |
| Bacterial Culture Swab | $187 | 0% | $187 |
Medium |
| Biopsy - Skin Lesion | $1,514 | 0% | $1,514 |
Medium |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $85 | 0% | $85 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $126 | 0% | $126 |
Medium |
| Blood Test - Clotting Time | $62 | 0% | $62 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | 0% | $67 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $70 | 0% | $70 |
Medium |
| Blood Test - General Health Panel | $270 | 0% | $270 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $54 | 0% | $54 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $181 | 0% | $181 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $111 | 0% | $111 |
Medium |
| Blood Test - Vitamin D-3 Level | $186 | 0% | $186 |
Medium |
| Bone Density Scan (outpatient) | $681 | 0% | $681 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,625 | 0% | $2,625 |
Medium |
| Destruction of Lesion (outpatient) | $665 | 0% | $665 |
Medium |
| Destruction of Lesions, up to 14 | $820 | 0% | $820 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $188 | 0% | $188 |
Medium |
| Electrocardiogram (ECG or EKG) | $530 | 0% | $530 |
Medium |
| Mammogram (outpatient) | $523 | 0% | $523 |
Medium |
| MRI - Back (outpatient) | $3,379 | 0% | $3,379 |
Medium |
| MRI - Brain (outpatient) | $6,947 | 0% | $6,947 |
Medium |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 |
Medium |
| Office Visit - Basic | $162 | 0% | $162 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $294 | 0% | $294 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $468 | 0% | $468 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $461 | 0% | $461 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $521 | 0% | $521 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $294 | 0% | $294 |
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 | $310 | 0% | $310 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $370 | 0% | $370 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $403 | 0% | $403 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $440 | 0% | $440 |
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 | $289 | 0% | $289 |
Medium |
| Office Visit - Established Patient, High Complexity | $492 | 0% | $492 |
Medium |
| Office Visit - Established Patient, Low Complexity | $226 | 0% | $226 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $344 | 0% | $344 |
Medium |
| Office Visit - New Patient, Low Complexity | $344 | 0% | $344 |
Medium |
| Office Visit - New Patient, Minor | $260 | 0% | $260 |
Medium |
| Pap Test | $236 | 0% | $236 |
Medium |
| Physical Therapy - Therapeutic Exercises | $88 | 0% | $88 |
Medium |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $191 | 0% | $191 |
Medium |
| Ultrasound - Breast (outpatient) | $831 | 0% | $831 |
Medium |
| Ultrasound - Pelvic (outpatient) | $572 | 0% | $572 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $981 | 0% | $981 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,246 | 0% | $1,246 |
Medium |
| Urine Test - Automated with Microscope Examination | $54 | 0% | $54 |
Medium |
| Urine Test - Automated without Microscope | $191 | 0% | $191 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $87 | 0% | $87 |
Medium |
| Urine Test - Pregnancy | $59 | 0% | $59 |
Medium |
| X-Ray - Ankle (outpatient) | $469 | 0% | $469 |
Medium |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
Medium |
| X-Ray - Foot (outpatient) | $575 | 0% | $575 |
Medium |
| X-Ray - Hand | $611 | 0% | $611 | 
High |
| X-Ray - Hip | $624 | 0% | $624 |
Medium |
| X-Ray - Knee (outpatient) | $442 | 0% | $442 |
Medium |
| X-Ray - Shoulder (outpatient) | $587 | 0% | $587 |
Medium |
| X-Ray - Spine (outpatient) | $564 | 0% | $564 | 
Low |
