| Arthrocentesis (outpatient) | $892 | 0% | $892 | 
High |
| 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) | $74 | 0% | $74 |
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 - General Health Panel | $225 | 0% | $225 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $131 | 0% | $131 |
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 | $186 | 0% | $186 |
Medium |
| Bone Density Scan (outpatient) | $100 | 0% | $100 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,698 | 0% | $2,698 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,060 | 0% | $3,060 |
Medium |
| Destruction of Lesion (outpatient) | $685 | 0% | $685 |
High |
| Mammogram (outpatient) | $1,012 | 0% | $1,012 |
Medium |
| MRI - Back (outpatient) | $3,784 | 0% | $3,784 |
Medium |
| MRI - Brain (outpatient) | $7,455 | 0% | $7,455 |
Medium |
| MRI - Knee (outpatient) | $2,973 | 0% | $2,973 |
Medium |
| MRI - Pelvis (outpatient) | $5,903 | 0% | $5,903 |
High |
| Office Visit - Basic | $147 | 0% | $147 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $420 | 0% | $420 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $489 | 0% | $489 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $336 | 0% | $336 |
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 | $368 | 0% | $368 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $401 | 0% | $401 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $336 | 0% | $336 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $273 | 0% | $273 |
Medium |
| Office Visit - Established Patient, High Complexity | $450 | 0% | $450 |
Medium |
| Office Visit - Established Patient, Low Complexity | $206 | 0% | $206 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $312 | 0% | $312 |
Medium |
| Office Visit - New Patient, Low Complexity | $327 | 0% | $327 |
Medium |
| Office Visit - New Patient, Minor | $247 | 0% | $247 |
Medium |
| Pap Test | $236 | 0% | $236 |
Medium |
| Psychotherapy - Group Session | $28 | 0% | $28 |
Medium |
| Strep Test (Streptococcus, group A) | $98 | 0% | $98 |
Medium |
| Ultrasound - Breast (outpatient) | $786 | 0% | $786 |
Medium |
| Ultrasound - Pelvic (outpatient) | $767 | 0% | $767 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $932 | 0% | $932 | 
Low |
| 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 - Bacterial Culture | $87 | 0% | $87 |
Medium |
| Urine Test - Chlamydia | $102 | 0% | $102 |
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 - Wrist (outpatient) | $653 | 0% | $653 |
High |
