| Ambulance Service - Emergency Transport, Advanced Life Support | $1,195 | 0% | $1,195 | 
Medium |
| Ambulance Service - Mileage Rate for Ambulance Transport | $26 | 0% | $26 |
Medium |
| Arthrocentesis (outpatient) | $1,530 | 0% | $1,530 |
Medium |
| Arthroscopic Knee Surgery (outpatient) | $12,045 | 0% | $12,045 |
Medium |
| Arthroscopic Shoulder Surgery | $39,161 | 0% | $39,161 | 
High |
| Biopsy - Breast | $6,171 | 0% | $6,171 |
High |
| Biopsy - Endometrial (Uterus) | $1,198 | 0% | $1,198 |
Medium |
| Blood Test - Basic Metabolic Panel | $134 | 0% | $134 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 0% | $90 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $153 | 0% | $153 |
Medium |
| Blood Test - Clotting Time | $77 | 0% | $77 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $80 | 0% | $80 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $110 | 0% | $110 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $153 | 0% | $153 |
Medium |
| Blood Test - Electrolytes Panel | $120 | 0% | $120 |
Medium |
| Blood Test - General Health Panel | $263 | 0% | $263 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $127 | 0% | $127 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $243 | 0% | $243 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $100 | 0% | $100 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $127 | 0% | $127 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $170 | 0% | $170 |
Medium |
| Blood Test - Vitamin D-3 Level | $83 | 0% | $83 |
Medium |
| Bone Density Scan (outpatient) | $612 | 0% | $612 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $4,964 | 0% | $4,964 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,781 | 0% | $4,781 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,422 | 0% | $2,422 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,677 | 0% | $1,677 |
Medium |
| Cystoscopy | $977 | 0% | $977 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $425 | 0% | $425 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $265 | 0% | $265 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $592 | 0% | $592 |
Medium |
| Fetal Non-Stress Test | $1,489 | 0% | $1,489 |
Medium |
| Gall Bladder Surgery (outpatient) | $9,421 | 0% | $9,421 |
High |
| Mammogram (outpatient) | $1,036 | 0% | $1,036 |
Medium |
| MRI - Knee (outpatient) | $2,489 | 0% | $2,489 |
Medium |
| Myocardial Imaging (outpatient) | $4,950 | 0% | $4,950 |
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, Younger than 1 Year Old | $336 | 0% | $336 |
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, 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 | $246 | 0% | $246 |
Medium |
| Office Visit - New Patient, Low Complexity | $340 | 0% | $340 |
Medium |
| Strep Test (Streptococcus, group A) | $81 | 0% | $81 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $134 | 0% | $134 |
Medium |
| Ultrasound - Abdominal, Complete | $1,335 | 0% | $1,335 |
Medium |
| Ultrasound - Abdominal, Limited | $954 | 0% | $954 |
Medium |
| Ultrasound - Breast (outpatient) | $2,169 | 0% | $2,169 |
High |
| Ultrasound - Head and Neck | $790 | 0% | $790 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $629 | 0% | $629 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,608 | 0% | $4,608 |
Medium |
| Urine Test - Automated with Microscope Examination | $77 | 0% | $77 |
Medium |
| Urine Test - Automated without Microscope | $77 | 0% | $77 |
Medium |
| Urine Test - Bacterial Culture | $123 | 0% | $123 |
Medium |
| Urine Test - Chlamydia | $173 | 0% | $173 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $179 | 0% | $179 |
Medium |
| Urine Test - Pregnancy | $98 | 0% | $98 |
Medium |
| X-Ray - Abdomen | $1,111 | 0% | $1,111 |
Medium |
| X-Ray - Ankle (outpatient) | $563 | 0% | $563 |
Medium |
| X-Ray - Chest (outpatient) | $774 | 0% | $774 |
Medium |
| X-Ray - Foot (outpatient) | $540 | 0% | $540 |
Medium |
| X-Ray - Hand | $629 | 0% | $629 |
Medium |
| X-Ray - Hip | $669 | 0% | $669 |
Medium |
| X-Ray - Knee (outpatient) | $673 | 0% | $673 |
Medium |
| X-Ray - Neck, Cervical Spine | $953 | 0% | $953 |
Medium |
| X-Ray - Shoulder (outpatient) | $381 | 0% | $381 |
Medium |
| X-Ray - Spine (outpatient) | $986 | 0% | $986 |
Medium |
| X-Ray - Wrist (outpatient) | $760 | 0% | $760 |
High |
