| Arthrocentesis (outpatient) | $834 | 0% | $834 | 
Medium |
| Biopsy - Skin Lesion | $1,514 | 0% | $1,514 |
Medium |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $95 | 0% | $95 |
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 | $225 | 0% | $225 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 0% | $97 |
Medium |
| Blood Test - Vitamin D-3 Level | $186 | 0% | $186 |
Medium |
| Bone Density Scan (outpatient) | $649 | 0% | $649 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,497 | 0% | $2,497 |
Medium |
| Destruction of Lesion (outpatient) | $665 | 0% | $665 |
Medium |
| Destruction of Lesions, up to 14 | $701 | 0% | $701 |
Medium |
| Mammogram (outpatient) | $496 | 0% | $496 |
Medium |
| MRI - Back (outpatient) | $3,199 | 0% | $3,199 |
Medium |
| MRI - Brain (outpatient) | $6,456 | 0% | $6,456 |
Medium |
| MRI - Knee (outpatient) | $2,973 | 0% | $2,973 |
Medium |
| Office Visit - Basic | $153 | 0% | $153 |
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 | $443 | 0% | $443 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $437 | 0% | $437 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $494 | 0% | $494 |
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 | $293 | 0% | $293 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $350 | 0% | $350 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $382 | 0% | $382 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $417 | 0% | $417 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $293 | 0% | $293 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $273 | 0% | $273 |
Medium |
| Office Visit - Established Patient, High Complexity | $466 | 0% | $466 |
Medium |
| Office Visit - Established Patient, Low Complexity | $214 | 0% | $214 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $327 | 0% | $327 |
Medium |
| Office Visit - New Patient, Low Complexity | $327 | 0% | $327 |
Medium |
| Office Visit - New Patient, Minor | $247 | 0% | $247 |
Medium |
| Pap Test | $236 | 0% | $236 |
Medium |
| Strep Test (Streptococcus, group A) | $98 | 0% | $98 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $191 | 0% | $191 |
Medium |
| Ultrasound - Breast (outpatient) | $786 | 0% | $786 |
Medium |
| Ultrasound - Pelvic (outpatient) | $572 | 0% | $572 | 
High |
| Ultrasound - Pregnancy (outpatient) | $678 | 0% | $678 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $716 | 0% | $716 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $735 | 0% | $735 |
High |
| Urine Test - Automated with Microscope Examination | $171 | 0% | $171 |
Medium |
| Urine Test - Bacterial Culture | $87 | 0% | $87 |
Medium |
| Urine Test - Chlamydia | $158 | 0% | $158 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $158 | 0% | $158 |
Medium |
| Urine Test - Pregnancy | $59 | 0% | $59 |
Medium |
| X-Ray - Ankle (outpatient) | $524 | 0% | $524 |
Medium |
| X-Ray - Chest (outpatient) | $550 | 0% | $550 |
Medium |
| X-Ray - Foot (outpatient) | $524 | 0% | $524 |
Medium |
| X-Ray - Hand | $675 | 0% | $675 |
High |
| X-Ray - Hip | $591 | 0% | $591 |
Medium |
| X-Ray - Knee (outpatient) | $419 | 0% | $419 |
High |
| X-Ray - Shoulder (outpatient) | $557 | 0% | $557 |
Medium |
