| Ambulance Service - Emergency Transport, Advanced Life Support | $1,183 | 0% | $1,183 | 
Medium |
| Ambulance Service - Emergency Transport, Basic Life Support | $996 | 0% | $996 |
Medium |
| Ambulance Service - Mileage Rate for Ambulance Transport | $19 | 0% | $19 |
Medium |
| Arthrocentesis (outpatient) | $476 | 0% | $476 |
Medium |
| Bacterial Culture Swab | $17 | 0% | $17 |
Medium |
| Blood Test - Basic Metabolic Panel | $16 | 0% | $16 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $19 | 0% | $19 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $26 | 0% | $26 |
Medium |
| Blood Test - Clotting Time | $7 | 0% | $7 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $13 | 0% | $13 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $15 | 0% | $15 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $20 | 0% | $20 |
Medium |
| Blood Test - Electrolytes Panel | $14 | 0% | $14 |
Medium |
| Blood Test - Folic Acid Level | $28 | 0% | $28 |
Medium |
| Blood Test - General Health Panel | $67 | 0% | $67 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $16 | 0% | $16 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $25 | 0% | $25 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $14 | 0% | $14 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $146 | 0% | $146 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $28 | 0% | $28 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $17 | 0% | $17 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $33 | 0% | $33 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $17 | 0% | $17 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $23 | 0% | $23 |
Medium |
| Blood Test - Vitamin D-3 Level | $56 | 0% | $56 |
Medium |
| Bone Density Scan (outpatient) | $743 | 0% | $743 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,069 | 0% | $2,069 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,459 | 0% | $2,459 | 
High |
| Detection Test for Human Papillomavirus (HPV) | $59 | 0% | $59 |
Medium |
| Electrocardiogram (ECG or EKG) | $411 | 0% | $411 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | 0% | $17 |
Medium |
| Laryngoscopy - Diagnostic | $548 | 0% | $548 |
Medium |
| Mammogram (outpatient) | $761 | 0% | $761 |
Medium |
| MRI - Back (outpatient) | $2,844 | 0% | $2,844 |
Medium |
| MRI - Brain (outpatient) | $4,509 | 0% | $4,509 |
Medium |
| MRI - Knee (outpatient) | $2,856 | 0% | $2,856 |
Medium |
| MRI - Pelvis (outpatient) | $4,476 | 0% | $4,476 |
Medium |
| Nasal Endoscopy - Diagnostic | $627 | 0% | $627 |
Medium |
| Office Visit - Basic | $97 | 0% | $97 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $273 | 0% | $273 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $258 | 0% | $258 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $251 | 0% | $251 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $290 | 0% | $290 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $284 | 0% | $284 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $211 | 0% | $211 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $203 | 0% | $203 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $221 | 0% | $221 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $225 | 0% | $225 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $240 | 0% | $240 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $202 | 0% | $202 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $190 | 0% | $190 |
Medium |
| Office Visit - Established Patient, High Complexity | $317 | 0% | $317 |
Medium |
| Office Visit - Established Patient, Low Complexity | $160 | 0% | $160 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $235 | 0% | $235 |
Medium |
| Office Visit - New Patient, Low Complexity | $236 | 0% | $236 |
Medium |
| Office Visit - New Patient, Minor | $165 | 0% | $165 |
Medium |
| Physical Therapy - Therapeutic Exercises | $72 | 0% | $72 |
Medium |
| Strep Test (Streptococcus, group A) | $22 | 0% | $22 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | 0% | $12 |
Medium |
| Ultrasound - Breast (outpatient) | $868 | 0% | $868 |
Medium |
| Urine Capacity Measurement | $286 | 0% | $286 |
Medium |
| Urine Test - Automated with Microscope Examination | $6 | 0% | $6 |
Medium |
| Urine Test - Automated without Microscope | $3 | 0% | $3 |
Medium |
| Urine Test - Bacterial Culture | $8 | 0% | $8 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $13 | 0% | $13 |
Medium |
| Urine Test - Chlamydia | $48 | 0% | $48 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $49 | 0% | $49 |
Medium |
| Urine Test - Pregnancy | $13 | 0% | $13 |
Medium |
| X-Ray - Ankle (outpatient) | $355 | 0% | $355 |
Medium |
| X-Ray - Chest (outpatient) | $437 | 0% | $437 |
Medium |
| X-Ray - Foot (outpatient) | $340 | 0% | $340 |
Medium |
| X-Ray - Hip | $207 | 0% | $207 |
High |
| X-Ray - Knee (outpatient) | $202 | 0% | $202 |
High |
| X-Ray - Shoulder (outpatient) | $357 | 0% | $357 |
High |
| X-Ray - Spine (outpatient) | $423 | 0% | $423 |
Medium |
| X-Ray - Wrist (outpatient) | $378 | 0% | $378 |
High |
