| Arthrocentesis (outpatient) | $802 | 0% | $802 | 
High |
| Bacterial Culture Swab | $187 | 0% | $187 | 
Medium |
| Biopsy - Skin Lesion | $1,471 | 0% | $1,471 |
Medium |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
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 - Electrolytes Panel | $90 | 0% | $90 |
Medium |
| Blood Test - Folic Acid Level | $101 | 0% | $101 |
Medium |
| Blood Test - General Health Panel | $225 | 0% | $225 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $54 | 0% | $54 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $216 | 0% | $216 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $30 | 0% | $30 |
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 B-12 (Cyanocobalamin) Level | $97 | 0% | $97 |
Medium |
| Blood Test - Vitamin D-3 Level | $186 | 0% | $186 |
Medium |
| Bone Density Scan (outpatient) | $854 | 0% | $854 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,667 | 0% | $2,667 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,069 | 0% | $3,069 |
Medium |
| Destruction of Lesion (outpatient) | $600 | 0% | $600 |
Medium |
| Destruction of Lesions, up to 14 | $666 | 0% | $666 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $188 | 0% | $188 |
Medium |
| Electrocardiogram (ECG or EKG) | $789 | 0% | $789 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $149 | 0% | $149 |
Medium |
| Mammogram (outpatient) | $947 | 0% | $947 |
Medium |
| MRI - Back (outpatient) | $3,485 | 0% | $3,485 |
Medium |
| MRI - Brain (outpatient) | $7,455 | 0% | $7,455 |
Medium |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 |
Medium |
| MRI - Pelvis (outpatient) | $6,233 | 0% | $6,233 |
Medium |
| Office Visit - Basic | $131 | 0% | $131 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $442 | 0% | $442 |
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 | $407 | 0% | $407 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $354 | 0% | $354 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $368 | 0% | $368 |
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 | $422 | 0% | $422 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $354 | 0% | $354 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $301 | 0% | $301 |
Medium |
| Office Visit - Established Patient, High Complexity | $482 | 0% | $482 |
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 | $253 | 0% | $253 |
Medium |
| Pap Test | $236 | 0% | $236 |
Medium |
| Physical Therapy - Manual Therapy | $129 | 0% | $129 |
Medium |
| Physical Therapy - Therapeutic Exercises | $130 | 0% | $130 |
Medium |
| Psychotherapy - Group Session | $28 | 0% | $28 |
Medium |
| Strep Test (Streptococcus, group A) | $103 | 0% | $103 |
Medium |
| Ultrasound - Breast (outpatient) | $922 | 0% | $922 |
Medium |
| Ultrasound - Pelvic (outpatient) | $696 | 0% | $696 |
High |
| Ultrasound - Pregnancy (outpatient) | $1,077 | 0% | $1,077 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $956 | 0% | $956 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $683 | 0% | $683 |
Medium |
| Urine Test - Automated with Microscope Examination | $171 | 0% | $171 |
Medium |
| Urine Test - Automated without Microscope | $191 | 0% | $191 |
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 | $32 | 0% | $32 |
Medium |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
Medium |
| X-Ray - Shoulder (outpatient) | $735 | 0% | $735 |
Medium |
| X-Ray - Wrist (outpatient) | $582 | 0% | $582 |
Medium |
