| Arthrocentesis (outpatient) | $380 | 0% | $380 | 
Medium |
| Biopsy - Skin Lesion | $735 | 0% | $735 |
Medium |
| Blood Test - Basic Metabolic Panel | $36 | 0% | $36 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | 0% | $35 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $103 | 0% | $103 |
Medium |
| Blood Test - Clotting Time | $11 | 0% | $11 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $43 | 0% | $43 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | 0% | $26 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $77 | 0% | $77 |
Medium |
| Blood Test - General Health Panel | $277 | 0% | $277 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $43 | 0% | $43 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $152 | 0% | $152 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $65 | 0% | $65 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 0% | $112 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | 0% | $109 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 0% | $81 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | 0% | $49 |
Medium |
| Blood Test - Vitamin D-3 Level | $94 | 0% | $94 |
Medium |
| Destruction of Lesion (outpatient) | $399 | 0% | $399 |
Medium |
| Destruction of Lesions, up to 14 | $396 | 0% | $396 | 
High |
| Detection Test for Human Papillomavirus (HPV) | $153 | 0% | $153 |
Medium |
| Electrocardiogram (ECG or EKG) | $623 | 0% | $623 |
High |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $111 | 0% | $111 |
Medium |
| Mammogram (outpatient) | $1,198 | 0% | $1,198 |
Medium |
| Office Visit - Basic | $92 | 0% | $92 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | 0% | $228 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $256 | 0% | $256 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $275 | 0% | $275 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $307 | 0% | $307 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | 0% | $227 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | 0% | $224 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | 0% | $200 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $239 | 0% | $239 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $240 | 0% | $240 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | 0% | $263 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $195 | 0% | $195 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | 0% | $195 |
Medium |
| Office Visit - Established Patient, High Complexity | $307 | 0% | $307 |
Medium |
| Office Visit - Established Patient, Low Complexity | $153 | 0% | $153 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $228 | 0% | $228 |
Medium |
| Office Visit - New Patient, Low Complexity | $228 | 0% | $228 |
Medium |
| Office Visit - New Patient, Minor | $159 | 0% | $159 |
Medium |
| Pap Test | $218 | 0% | $218 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $243 | 0% | $243 |
Medium |
| Physical Therapy - Therapeutic Exercises | $128 | 0% | $128 |
Medium |
| Psychiatric Diagnostic Evaluation | $255 | 0% | $255 |
Medium |
| Psychotherapy - 30 Minutes | $137 | 0% | $137 |
Medium |
| Psychotherapy - 45 Minutes | $158 | 0% | $158 |
Medium |
| Psychotherapy - 60 Minutes | $158 | 0% | $158 |
Medium |
| Psychotherapy - Family Session | $192 | 0% | $192 |
Medium |
| Psychotherapy - Group Session | $63 | 0% | $63 |
Medium |
| Strep Test (Streptococcus, group A) | $44 | 0% | $44 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $85 | 0% | $85 |
Medium |
| Ultrasound - Breast (outpatient) | $1,877 | 0% | $1,877 |
Medium |
| Urine Test - Automated with Microscope Examination | $10 | 0% | $10 |
Medium |
| Urine Test - Automated without Microscope | $17 | 0% | $17 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 0% | $85 |
Medium |
| Urine Test - Chlamydia | $105 | 0% | $105 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $105 | 0% | $105 |
Medium |
| Urine Test - Pregnancy | $18 | 0% | $18 |
Medium |
| X-Ray - Foot (outpatient) | $739 | 0% | $739 | 
Low |
| X-Ray - Hand | $847 | 0% | $847 |
Medium |
