| Arthrocentesis (outpatient) | $880 | 0% | $880 | 
Medium |
| Biopsy - Skin Lesion | $1,100 | 0% | $1,100 |
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 - Hepatic (Liver) Function Panel | $154 | 0% | $154 |
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 | $117 | 0% | $117 |
Medium |
| Bone Density Scan (outpatient) | $649 | 0% | $649 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,497 | 0% | $2,497 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,064 | 0% | $2,064 |
Medium |
| Destruction of Lesion (outpatient) | $520 | 0% | $520 |
Medium |
| Destruction of Lesions, up to 14 | $516 | 0% | $516 |
Medium |
| Laryngoscopy - Diagnostic | $1,116 | 0% | $1,116 | 
High |
| Mammogram (outpatient) | $496 | 0% | $496 |
Medium |
| MRI - Back (outpatient) | $3,199 | 0% | $3,199 |
Medium |
| MRI - Brain (outpatient) | $6,498 | 0% | $6,498 |
Medium |
| MRI - Knee (outpatient) | $2,973 | 0% | $2,973 |
Medium |
| MRI - Pelvis (outpatient) | $5,883 | 0% | $5,883 |
High |
| 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 | $161 | 0% | $161 |
Medium |
| Pap Test | $225 | 0% | $225 |
Medium |
| Physical Therapy - Therapeutic Exercises | $147 | 0% | $147 |
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) | $451 | 0% | $451 |
Medium |
| Ultrasound - Pelvic (outpatient) | $542 | 0% | $542 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $678 | 0% | $678 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $464 | 0% | $464 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $521 | 0% | $521 |
Medium |
| Urine Test - Automated with Microscope Examination | $171 | 0% | $171 |
Medium |
| Urine Test - Automated without Microscope | $17 | 0% | $17 |
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) | $351 | 0% | $351 |
High |
| X-Ray - Chest (outpatient) | $550 | 0% | $550 |
Medium |
| X-Ray - Foot (outpatient) | $762 | 0% | $762 |
Medium |
| X-Ray - Knee (outpatient) | $431 | 0% | $431 |
Medium |
| X-Ray - Shoulder (outpatient) | $674 | 0% | $674 |
High |
