| Arthrocentesis (outpatient) | $897 | 0% | $897 | 
Medium |
| Bacterial Culture Swab | $187 | 0% | $187 |
Medium |
| Biopsy - Skin Lesion | $1,175 | 0% | $1,175 |
Medium |
| Blood Test - Basic Metabolic Panel | $48 | 0% | $48 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $74 | 0% | $74 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $41 | 0% | $41 |
Medium |
| Blood Test - Clotting Time | $62 | 0% | $62 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $79 | 0% | $79 |
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 - Folic Acid Level | $131 | 0% | $131 |
Medium |
| Blood Test - General Health Panel | $107 | 0% | $107 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $35 | 0% | $35 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $104 | 0% | $104 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $69 | 0% | $69 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 0% | $97 |
Medium |
| Blood Test - Vitamin D-3 Level | $185 | 0% | $185 |
Medium |
| Bone Density Scan (outpatient) | $681 | 0% | $681 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,612 | 0% | $2,612 |
Medium |
| Destruction of Lesion (outpatient) | $558 | 0% | $558 |
Medium |
| Destruction of Lesions, up to 14 | $671 | 0% | $671 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $188 | 0% | $188 |
Medium |
| Electrocardiogram (ECG or EKG) | $626 | 0% | $626 |
Medium |
| Mammogram (outpatient) | $523 | 0% | $523 |
Medium |
| MRI - Back (outpatient) | $3,379 | 0% | $3,379 |
Medium |
| MRI - Brain (outpatient) | $7,041 | 0% | $7,041 |
Medium |
| MRI - Knee (outpatient) | $3,140 | 0% | $3,140 | 
High |
| Office Visit - Basic | $162 | 0% | $162 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $389 | 0% | $389 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $468 | 0% | $468 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $461 | 0% | $461 |
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 | $247 | 0% | $247 |
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 | $20 | 0% | $20 |
Medium |
| Ultrasound - Breast (outpatient) | $831 | 0% | $831 |
Medium |
| Ultrasound - Pelvic (outpatient) | $557 | 0% | $557 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $716 | 0% | $716 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $490 | 0% | $490 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $898 | 0% | $898 |
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 | $59 | 0% | $59 |
Medium |
| X-Ray - Ankle (outpatient) | $615 | 0% | $615 |
Medium |
| X-Ray - Chest (outpatient) | $581 | 0% | $581 |
Medium |
| X-Ray - Foot (outpatient) | $553 | 0% | $553 |
Medium |
| X-Ray - Hand | $834 | 0% | $834 |
Medium |
| X-Ray - Knee (outpatient) | $546 | 0% | $546 |
Medium |
| X-Ray - Shoulder (outpatient) | $749 | 0% | $749 |
Medium |
