| Ambulance Service - Emergency Transport, Advanced Life Support | $1,022 | 0% | $1,022 | 
Medium |
| Ambulance Service - Mileage Rate for Ambulance Transport | $27 | 0% | $27 |
Medium |
| Arthrocentesis (outpatient) | $1,283 | 0% | $1,283 |
Medium |
| Arthroscopic Knee Surgery (outpatient) | $11,982 | 0% | $11,982 | 
High |
| Arthroscopic Shoulder Surgery | $40,450 | 0% | $40,450 |
Medium |
| Bacterial Culture Swab | $175 | 0% | $175 |
Medium |
| Biopsy - Breast | $5,816 | 0% | $5,816 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,153 | 0% | $1,153 |
Medium |
| Blood Test - Basic Metabolic Panel | $139 | 0% | $139 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $93 | 0% | $93 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $159 | 0% | $159 |
Medium |
| Blood Test - Clotting Time | $77 | 0% | $77 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $83 | 0% | $83 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $159 | 0% | $159 |
Medium |
| Blood Test - Electrolytes Panel | $124 | 0% | $124 |
Medium |
| Blood Test - General Health Panel | $271 | 0% | $271 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $131 | 0% | $131 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $168 | 0% | $168 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $67 | 0% | $67 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $250 | 0% | $250 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $106 | 0% | $106 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $131 | 0% | $131 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $175 | 0% | $175 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $198 | 0% | $198 |
Medium |
| Blood Test - Vitamin D-3 Level | $86 | 0% | $86 |
Medium |
| Bone Density Scan (outpatient) | $616 | 0% | $616 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $4,367 | 0% | $4,367 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,901 | 0% | $4,901 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,498 | 0% | $2,498 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,908 | 0% | $1,908 |
High |
| Emergency Department Visit - Low Complexity (outpatient) | $439 | 0% | $439 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $277 | 0% | $277 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $610 | 0% | $610 |
Medium |
| Fetal Non-Stress Test | $1,353 | 0% | $1,353 |
Medium |
| Gall Bladder Surgery (outpatient) | $8,876 | 0% | $8,876 |
Medium |
| Mammogram (outpatient) | $1,062 | 0% | $1,062 |
Medium |
| Office Visit - Basic | $144 | 0% | $144 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $401 | 0% | $401 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $453 | 0% | $453 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $394 | 0% | $394 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $321 | 0% | $321 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $323 | 0% | $323 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $360 | 0% | $360 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $373 | 0% | $373 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $394 | 0% | $394 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $341 | 0% | $341 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $302 | 0% | $302 |
Medium |
| Office Visit - Established Patient, High Complexity | $427 | 0% | $427 |
Medium |
| Office Visit - Established Patient, Low Complexity | $201 | 0% | $201 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $270 | 0% | $270 |
Medium |
| Office Visit - New Patient, Low Complexity | $340 | 0% | $340 |
Medium |
| Office Visit - New Patient, Minor | $231 | 0% | $231 |
Medium |
| Strep Test (Streptococcus, group A) | $53 | 0% | $53 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $134 | 0% | $134 |
Medium |
| Ultrasound - Abdominal, Complete | $1,370 | 0% | $1,370 |
Medium |
| Ultrasound - Abdominal, Limited | $981 | 0% | $981 |
Medium |
| Ultrasound - Breast (outpatient) | $2,226 | 0% | $2,226 |
Medium |
| Ultrasound - Head and Neck | $790 | 0% | $790 |
Medium |
| Ultrasound - Pelvic (outpatient) | $936 | 0% | $936 |
High |
| Ultrasound - Pregnancy Follow-Up | $753 | 0% | $753 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,784 | 0% | $4,784 |
Medium |
| Urine Test - Automated with Microscope Examination | $77 | 0% | $77 |
Medium |
| Urine Test - Automated without Microscope | $80 | 0% | $80 |
Medium |
| Urine Test - Chlamydia | $185 | 0% | $185 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $185 | 0% | $185 |
Medium |
| Urine Test - Pregnancy | $101 | 0% | $101 |
Medium |
| X-Ray - Abdomen | $1,147 | 0% | $1,147 |
Medium |
| X-Ray - Ankle (outpatient) | $602 | 0% | $602 |
Medium |
| X-Ray - Chest (outpatient) | $731 | 0% | $731 |
Medium |
| X-Ray - Foot (outpatient) | $604 | 0% | $604 |
High |
| X-Ray - Hand | $667 | 0% | $667 |
Medium |
| X-Ray - Hip | $886 | 0% | $886 |
High |
| X-Ray - Knee (outpatient) | $661 | 0% | $661 |
Medium |
| X-Ray - Neck, Cervical Spine | $953 | 0% | $953 |
Medium |
| X-Ray - Shoulder (outpatient) | $423 | 0% | $423 |
Medium |
| X-Ray - Spine (outpatient) | $1,020 | 0% | $1,020 |
Medium |
| X-Ray - Wrist (outpatient) | $757 | 0% | $757 |
Medium |
