| Arthrocentesis (outpatient) | $892 | 0% | $892 | 
Medium |
| Bacterial Culture Swab | $187 | 0% | $187 |
Medium |
| Biopsy - Skin Lesion | $1,027 | 0% | $1,027 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $109 | 0% | $109 |
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 - Comprehensive Metabolic Panel | $60 | 0% | $60 |
Medium |
| Blood Test - General Health Panel | $199 | 0% | $199 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $216 | 0% | $216 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $95 | 0% | $95 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $111 | 0% | $111 |
Medium |
| Blood Test - Vitamin D-3 Level | $287 | 0% | $287 |
Medium |
| Bone Density Scan (outpatient) | $681 | 0% | $681 | 
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,625 | 0% | $2,625 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,172 | 0% | $2,172 |
Medium |
| Destruction of Lesion (outpatient) | $546 | 0% | $546 |
Medium |
| Destruction of Lesions, up to 14 | $585 | 0% | $585 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $188 | 0% | $188 |
Medium |
| Electrocardiogram (ECG or EKG) | $546 | 0% | $546 |
Medium |
| Laryngoscopy - Diagnostic | $1,179 | 0% | $1,179 |
Medium |
| Mammogram (outpatient) | $523 | 0% | $523 |
Medium |
| MRI - Back (outpatient) | $3,379 | 0% | $3,379 |
High |
| MRI - Brain (outpatient) | $6,936 | 0% | $6,936 |
Medium |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 |
Medium |
| MRI - Pelvis (outpatient) | $6,330 | 0% | $6,330 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,232 | 0% | $1,232 |
Medium |
| Office Visit - Basic | $153 | 0% | $153 |
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 | $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 | $159 | 0% | $159 |
Medium |
| Pap Test | $236 | 0% | $236 |
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 | $490 | 0% | $490 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $550 | 0% | $550 |
Medium |
| Urine Test - Automated with Microscope Examination | $112 | 0% | $112 |
Medium |
| Urine Test - Automated without Microscope | $17 | 0% | $17 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $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) | $371 | 0% | $371 |
Medium |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
Medium |
| X-Ray - Foot (outpatient) | $687 | 0% | $687 |
High |
| X-Ray - Knee (outpatient) | $624 | 0% | $624 |
Medium |
| X-Ray - Shoulder (outpatient) | $606 | 0% | $606 |
High |
