| Arthrocentesis (outpatient) | $716 | 0% | $716 | 
Medium |
| Bacterial Culture Swab | $124 | 0% | $124 |
Medium |
| Biopsy - Skin Lesion | $1,458 | 0% | $1,458 |
Medium |
| Blood Test - Basic Metabolic Panel | $168 | 0% | $168 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $23 | 0% | $23 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $146 | 0% | $146 |
Medium |
| Blood Test - Clotting Time | $62 | 0% | $62 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $62 | 0% | $62 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $69 | 0% | $69 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $92 | 0% | $92 |
Medium |
| Blood Test - General Health Panel | $199 | 0% | $199 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $74 | 0% | $74 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $113 | 0% | $113 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $149 | 0% | $149 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 0% | $151 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $106 | 0% | $106 |
Medium |
| Blood Test - Vitamin D-3 Level | $292 | 0% | $292 |
Medium |
| Bone Density Scan (outpatient) | $681 | 0% | $681 |
Medium |
| Destruction of Lesion (outpatient) | $611 | 0% | $611 |
Medium |
| Destruction of Lesions, up to 14 | $665 | 0% | $665 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $234 | 0% | $234 |
Medium |
| Electrocardiogram (ECG or EKG) | $795 | 0% | $795 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | 0% | $17 |
Medium |
| Laryngoscopy - Diagnostic | $1,179 | 0% | $1,179 |
Medium |
| Mammogram (outpatient) | $1,051 | 0% | $1,051 |
Medium |
| MRI - Knee (outpatient) | $2,684 | 0% | $2,684 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,232 | 0% | $1,232 |
Medium |
| Office Visit - Basic | $162 | 0% | $162 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $389 | 0% | $389 |
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 | $408 | 0% | $408 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $368 | 0% | $368 |
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 | $176 | 0% | $176 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $352 | 0% | $352 |
Medium |
| Physical Therapy - Manual Therapy | $121 | 0% | $121 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $246 | 0% | $246 |
Medium |
| Physical Therapy - Therapeutic Exercises | $141 | 0% | $141 |
Medium |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | 0% | $12 |
Medium |
| Ultrasound - Pelvic (outpatient) | $542 | 0% | $542 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 | 
High |
| Ultrasound - Pregnancy Follow-Up | $490 | 0% | $490 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,418 | 0% | $1,418 |
Medium |
| Urine Test - Automated with Microscope Examination | $54 | 0% | $54 |
Medium |
| Urine Test - Automated without Microscope | $26 | 0% | $26 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $13 | 0% | $13 |
Medium |
| Urine Test - Chlamydia | $213 | 0% | $213 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $213 | 0% | $213 |
Medium |
| Urine Test - Pregnancy | $59 | 0% | $59 |
Medium |
| X-Ray - Ankle (outpatient) | $644 | 0% | $644 |
Medium |
| X-Ray - Foot (outpatient) | $750 | 0% | $750 |
High |
| X-Ray - Hand | $670 | 0% | $670 |
Medium |
| X-Ray - Knee (outpatient) | $749 | 0% | $749 |
Medium |
| X-Ray - Shoulder (outpatient) | $873 | 0% | $873 |
Medium |
| X-Ray - Wrist (outpatient) | $873 | 0% | $873 |
Medium |
