| Ambulance Service - Emergency Transport, Advanced Life Support | $1,298 | 0% | $1,298 | 
Medium |
| Ambulance Service - Emergency Transport, Basic Life Support | $840 | 0% | $840 |
Medium |
| Ambulance Service - Mileage Rate for Ambulance Transport | $32 | 0% | $32 |
Medium |
| Ambulance Service - Non-Emergency Transport, Advanced Life Support | $1,193 | 0% | $1,193 |
Medium |
| Ambulance Service - Non-Emergency Transport, Basic Life Support | $735 | 0% | $735 |
Medium |
| Bacterial Culture Swab | $53 | 0% | $53 |
Medium |
| Blood Test - Basic Metabolic Panel | $56 | 0% | $56 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $65 | 0% | $65 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $77 | 0% | $77 |
Medium |
| Blood Test - Clotting Time | $40 | 0% | $40 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $31 | 0% | $31 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $57 | 0% | $57 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $86 | 0% | $86 |
Medium |
| Blood Test - Electrolytes Panel | $44 | 0% | $44 |
Medium |
| Blood Test - Folic Acid Level | $101 | 0% | $101 |
Medium |
| Blood Test - General Health Panel | $240 | 0% | $240 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $76 | 0% | $76 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $51 | 0% | $51 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $47 | 0% | $47 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $98 | 0% | $98 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $51 | 0% | $51 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $105 | 0% | $105 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $91 | 0% | $91 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $93 | 0% | $93 |
Medium |
| Blood Test - Vitamin D-3 Level | $129 | 0% | $129 |
Medium |
| Bone Density Scan (outpatient) | $491 | 0% | $491 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,751 | 0% | $4,751 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $6,048 | 0% | $6,048 | 
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,800 | 0% | $3,800 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,222 | 0% | $2,222 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,633 | 0% | $1,633 |
High |
| Detection Test for Human Papillomavirus (HPV) | $376 | 0% | $376 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $306 | 0% | $306 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $227 | 0% | $227 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $434 | 0% | $434 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $84 | 0% | $84 |
Medium |
| Fetal Non-Stress Test | $1,208 | 0% | $1,208 |
Medium |
| Mammogram (outpatient) | $899 | 0% | $899 |
Medium |
| MRI - Back (outpatient) | $963 | 0% | $963 |
High |
| MRI - Brain (outpatient) | $1,322 | 0% | $1,322 |
Medium |
| MRI - Knee (outpatient) | $1,999 | 0% | $1,999 |
Medium |
| Myocardial Imaging (outpatient) | $5,705 | 0% | $5,705 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $394 | 0% | $394 |
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 | $389 | 0% | $389 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $315 | 0% | $315 |
Medium |
| Physical Therapy - Application of Hot or Cold Pack | $65 | 0% | $65 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $151 | 0% | $151 |
Medium |
| Physical Therapy - Manual Therapy | $105 | 0% | $105 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $81 | 0% | $81 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $120 | 0% | $120 |
Medium |
| Physical Therapy - Therapeutic Exercises | $97 | 0% | $97 |
Medium |
| Strep Test (Streptococcus, group A) | $76 | 0% | $76 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $41 | 0% | $41 |
Medium |
| Ultrasound - Abdominal, Complete | $1,380 | 0% | $1,380 |
Medium |
| Ultrasound - Abdominal, Limited | $742 | 0% | $742 |
Medium |
| Ultrasound - Breast (outpatient) | $1,261 | 0% | $1,261 |
Medium |
| Ultrasound - Head and Neck | $705 | 0% | $705 |
Medium |
| Ultrasound - Pelvic (outpatient) | $868 | 0% | $868 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $522 | 0% | $522 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $780 | 0% | $780 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,069 | 0% | $6,069 |
Medium |
| Urine Test - Automated with Microscope Examination | $30 | 0% | $30 |
Medium |
| Urine Test - Bacterial Culture | $45 | 0% | $45 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $67 | 0% | $67 |
Medium |
| Urine Test - Chlamydia | $146 | 0% | $146 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $146 | 0% | $146 |
Medium |
| Urine Test - Pregnancy | $33 | 0% | $33 |
Medium |
| X-Ray - Ankle (outpatient) | $348 | 0% | $348 |
Medium |
| X-Ray - Chest (outpatient) | $598 | 0% | $598 |
Medium |
| X-Ray - Foot (outpatient) | $607 | 0% | $607 |
Medium |
| X-Ray - Spine (outpatient) | $930 | 0% | $930 | 
Low |
