| Biopsy - Breast | $4,639 | 0% | $4,639 | 
Medium |
| Biopsy - Endometrial (Uterus) | $1,175 | 0% | $1,175 | 
High |
| Blood Test - Basic Metabolic Panel | $62 | 0% | $62 |
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 | $63 | 0% | $63 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $36 | 0% | $36 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $34 | 0% | $34 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $76 | 0% | $76 |
Medium |
| Blood Test - General Health Panel | $221 | 0% | $221 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $62 | 0% | $62 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $103 | 0% | $103 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $111 | 0% | $111 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $44 | 0% | $44 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $63 | 0% | $63 |
Medium |
| Blood Test - Vitamin D-3 Level | $196 | 0% | $196 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,722 | 0% | $4,722 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,373 | 0% | $5,373 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,160 | 0% | $2,160 |
Medium |
| Destruction of Lesion (outpatient) | $576 | 0% | $576 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $641 | 0% | $641 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $641 | 0% | $641 |
Medium |
| Fetal Non-Stress Test | $1,691 | 0% | $1,691 |
Medium |
| Mammogram (outpatient) | $802 | 0% | $802 |
Medium |
| MRI - Back (outpatient) | $2,821 | 0% | $2,821 |
Medium |
| MRI - Brain (outpatient) | $3,257 | 0% | $3,257 |
Medium |
| Office Visit - Basic | $131 | 0% | $131 |
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 | $411 | 0% | $411 |
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 | $305 | 0% | $305 |
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 | $394 | 0% | $394 |
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 | $291 | 0% | $291 |
Medium |
| Office Visit - New Patient, Minor | $210 | 0% | $210 |
Medium |
| Pap Test | $138 | 0% | $138 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $57 | 0% | $57 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $279 | 0% | $279 |
Medium |
| Physical Therapy - Manual Therapy | $111 | 0% | $111 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $279 | 0% | $279 |
Medium |
| Physical Therapy - Therapeutic Exercises | $122 | 0% | $122 |
Medium |
| Strep Test (Streptococcus, group A) | $42 | 0% | $42 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $39 | 0% | $39 |
Medium |
| Ultrasound - Abdominal, Complete | $746 | 0% | $746 |
Medium |
| Ultrasound - Breast (outpatient) | $1,268 | 0% | $1,268 |
Medium |
| Ultrasound - Head and Neck | $591 | 0% | $591 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $613 | 0% | $613 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,263 | 0% | $6,263 |
Medium |
| Urine Capacity Measurement | $445 | 0% | $445 |
Medium |
| Urine Test - Automated without Microscope | $13 | 0% | $13 |
Medium |
| Urine Test - Bacterial Culture | $48 | 0% | $48 |
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 |
Medium |
| X-Ray - Chest (outpatient) | $473 | 0% | $473 |
Medium |
| X-Ray - Foot (outpatient) | $406 | 0% | $406 |
Medium |
| X-Ray - Spine (outpatient) | $689 | 0% | $689 |
Medium |
