| Arthrocentesis (outpatient) | $797 | 0% | $797 | 
Medium |
| Biopsy - Skin Lesion | $1,206 | 0% | $1,206 |
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 | $138 | 0% | $138 |
Medium |
| Blood Test - Clotting Time | $62 | 0% | $62 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $40 | 0% | $40 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 0% | $66 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $134 | 0% | $134 |
Medium |
| Blood Test - General Health Panel | $233 | 0% | $233 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $168 | 0% | $168 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 0% | $151 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $126 | 0% | $126 |
Medium |
| Blood Test - Vitamin D-3 Level | $233 | 0% | $233 |
Medium |
| Bone Density Scan (outpatient) | $649 | 0% | $649 |
Medium |
| Destruction of Lesion (outpatient) | $580 | 0% | $580 | 
High |
| Destruction of Lesions, up to 14 | $665 | 0% | $665 |
Medium |
| Laryngoscopy - Diagnostic | $1,116 | 0% | $1,116 |
Medium |
| Mammogram (outpatient) | $1,012 | 0% | $1,012 |
Medium |
| MRI - Knee (outpatient) | $2,684 | 0% | $2,684 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,166 | 0% | $1,166 |
Medium |
| Office Visit - Basic | $153 | 0% | $153 |
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, 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 |
| Physical Therapy - Electrical Stimulation Therapy | $26 | 0% | $26 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $239 | 0% | $239 |
Medium |
| Physical Therapy - Manual Therapy | $58 | 0% | $58 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $53 | 0% | $53 |
Medium |
| Physical Therapy - Re-Evaluation | $74 | 0% | $74 |
Medium |
| Physical Therapy - Therapeutic Activities | $53 | 0% | $53 |
Medium |
| Physical Therapy - Therapeutic Exercises | $53 | 0% | $53 |
Medium |
| Strep Test (Streptococcus, group A) | $98 | 0% | $98 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $35 | 0% | $35 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $678 | 0% | $678 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $464 | 0% | $464 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $604 | 0% | $604 |
Medium |
| Urine Capacity Measurement | $582 | 0% | $582 |
Medium |
| Urine Test - Automated with Microscope Examination | $51 | 0% | $51 |
Medium |
| Urine Test - Automated without Microscope | $25 | 0% | $25 |
Medium |
| Urine Test - Bacterial Culture | $32 | 0% | $32 |
Medium |
| Urine Test - Chlamydia | $133 | 0% | $133 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $159 | 0% | $159 |
Medium |
| Urine Test - Pregnancy | $59 | 0% | $59 |
Medium |
| X-Ray - Ankle (outpatient) | $644 | 0% | $644 |
Medium |
| X-Ray - Foot (outpatient) | $637 | 0% | $637 |
Medium |
| X-Ray - Knee (outpatient) | $966 | 0% | $966 |
Medium |
| X-Ray - Shoulder (outpatient) | $832 | 0% | $832 |
Medium |
| X-Ray - Wrist (outpatient) | $894 | 0% | $894 |
Medium |
