| Bacterial Culture Swab | $49 | 0% | $49 | 
Medium |
| Blood Test - Basic Metabolic Panel | $64 | 0% | $64 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $57 | 0% | $57 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $72 | 0% | $72 |
Medium |
| Blood Test - Clotting Time | $65 | 0% | $65 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $36 | 0% | $36 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $35 | 0% | $35 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $76 | 0% | $76 |
Medium |
| Blood Test - Electrolytes Panel | $35 | 0% | $35 |
Medium |
| Blood Test - Folic Acid Level | $79 | 0% | $79 |
Medium |
| Blood Test - General Health Panel | $229 | 0% | $229 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $62 | 0% | $62 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $101 | 0% | $101 |
Medium |
| Blood Test - LDL Cholesterol Level | $53 | 0% | $53 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $51 | 0% | $51 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $103 | 0% | $103 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $64 | 0% | $64 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $113 | 0% | $113 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $46 | 0% | $46 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $65 | 0% | $65 |
Medium |
| Blood Test - Vitamin D-3 Level | $203 | 0% | $203 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,343 | 0% | $5,343 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,142 | 0% | $5,142 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,227 | 0% | $2,227 |
Medium |
| Destruction of Lesion (outpatient) | $356 | 0% | $356 | 
Low |
| Detection Test for Human Papillomavirus (HPV) | $194 | 0% | $194 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $660 | 0% | $660 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $660 | 0% | $660 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $46 | 0% | $46 |
Medium |
| Fetal Non-Stress Test | $1,148 | 0% | $1,148 |
Low |
| Mammogram (outpatient) | $783 | 0% | $783 |
Medium |
| MRI - Back (outpatient) | $2,854 | 0% | $2,854 |
Medium |
| MRI - Brain (outpatient) | $3,387 | 0% | $3,387 |
Medium |
| MRI - Knee (outpatient) | $2,616 | 0% | $2,616 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,616 | 0% | $2,616 |
Medium |
| Office Visit - Basic | $137 | 0% | $137 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $254 | 0% | $254 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $411 | 0% | $411 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $439 | 0% | $439 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $244 | 0% | $244 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $234 | 0% | $234 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $255 | 0% | $255 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $305 | 0% | $305 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $319 | 0% | $319 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $233 | 0% | $233 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $218 | 0% | $218 |
Medium |
| Office Visit - Established Patient, High Complexity | $420 | 0% | $420 |
Medium |
| Office Visit - Established Patient, Low Complexity | $210 | 0% | $210 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $301 | 0% | $301 |
Medium |
| Office Visit - New Patient, Low Complexity | $305 | 0% | $305 |
Medium |
| Office Visit - New Patient, Minor | $212 | 0% | $212 |
Medium |
| Pap Test | $143 | 0% | $143 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $279 | 0% | $279 |
Medium |
| Physical Therapy - Manual Therapy | $113 | 0% | $113 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $288 | 0% | $288 |
Medium |
| Physical Therapy - Therapeutic Exercises | $126 | 0% | $126 |
Medium |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $41 | 0% | $41 |
Medium |
| Ultrasound - Abdominal, Complete | $746 | 0% | $746 |
Medium |
| Ultrasound - Abdominal, Limited | $531 | 0% | $531 |
Low |
| Ultrasound - Breast (outpatient) | $1,298 | 0% | $1,298 |
Medium |
| Ultrasound - Head and Neck | $511 | 0% | $511 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $618 | 0% | $618 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,431 | 0% | $4,431 |
Medium |
| Urine Capacity Measurement | $445 | 0% | $445 |
Medium |
| Urine Test - Automated with Microscope Examination | $21 | 0% | $21 |
Medium |
| Urine Test - Automated without Microscope | $13 | 0% | $13 |
Medium |
| Urine Test - Bacterial Culture | $48 | 0% | $48 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $50 | 0% | $50 |
Medium |
| Urine Test - Chlamydia | $139 | 0% | $139 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $139 | 0% | $139 |
Medium |
| Urine Test - Pregnancy | $43 | 0% | $43 |
Medium |
| X-Ray - Abdomen | $484 | 0% | $484 | 
High |
| X-Ray - Chest (outpatient) | $502 | 0% | $502 |
Medium |
| X-Ray - Foot (outpatient) | $434 | 0% | $434 |
Medium |
