Ambulance Service - Mileage Rate for Ambulance Transport | $37 | 58% | $15 |
Ambulance Service - Non-Emergency Transport, Advanced Life Support | $956 | 58% | $401 |
Ambulance Service - Non-Emergency Transport, Basic Life Support | $665 | 58% | $279 |
Arthrocentesis (outpatient) | $2,144 | 58% | $900 |
Arthroscopic Knee Surgery (outpatient) | $20,348 | 58% | $8,546 |
Bacterial Culture - Aerobic Isolates | $101 | 58% | $42 |
Bacterial Culture - Swab | $187 | 58% | $78 |
Biopsy - Breast | $4,437 | 58% | $1,864 |
Biopsy - Endometrial (Uterus) | $1,699 | 58% | $714 |
Biopsy - Punch Biopsy of Skin | $1,935 | 58% | $813 |
Biopsy - Tangential Biopsy of Skin | $1,483 | 58% | $623 |
Blood Test - Basic Metabolic Panel | $48 | 58% | $20 |
Blood Test - Blood Glucose Control (Hemoglobin A1C) | $98 | 58% | $41 |
Blood Test - Cholesterol Test, Lipid Panel | $95 | 58% | $40 |
Blood Test - Clotting Time | $50 | 58% | $21 |
Blood Test - Coagulation Assessment | $51 | 58% | $22 |
Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | 58% | $28 |
Blood Test - Complete Blood Cell Count and Automated WBC | $70 | 58% | $30 |
Blood Test - Comprehensive Metabolic Panel | $60 | 58% | $25 |
Blood Test - Electrolytes Panel | $37 | 58% | $15 |
Blood Test - Ferritin (Blood Protein) Level | $78 | 58% | $33 |
Blood Test - Folic Acid Level | $101 | 58% | $42 |
Blood Test - General Health Panel | $225 | 58% | $94 |
Blood Test - Hepatic (Liver) Function Panel | $54 | 58% | $22 |
Blood Test - Hepatitis C Antibody Level | $216 | 58% | $91 |
Blood Test - Iron Level | $28 | 58% | $12 |
Blood Test - LDL Cholesterol Level | $66 | 58% | $28 |
Blood Test - Lipase (fat enzyme) Level | $30 | 58% | $13 |
Blood Test - Prostate Specific Antigen (PSA) Level | $112 | 58% | $47 |
Blood Test - Renal (Kidney) Function Panel | $81 | 58% | $34 |
Blood Test - Thyroid Stimulating Hormone (TSH) Level | $95 | 58% | $40 |
Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $111 | 58% | $47 |
Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $85 | 58% | $36 |
Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 58% | $41 |
Blood Test - Vitamin D-3 Level | $186 | 58% | $78 |
Bone Density Scan (outpatient) | $781 | 58% | $328 |
Colonoscopy - Diagnostic (outpatient) | $5,960 | 58% | $2,503 |
Colonoscopy - With Biopsy (outpatient) | $8,150 | 58% | $3,423 |
Colonoscopy - With Polyp Removal (outpatient) | $8,822 | 58% | $3,705 |
CT Scan - Abdomen and Pelvis, with Contrast | $6,942 | 58% | $2,915 |
CT Scan - Chest, with Contrast (outpatient) | $5,305 | 58% | $2,228 |
CT Scan - Head/Brain, without Contrast | $3,117 | 58% | $1,309 |
Cystoscopy | $3,537 | 58% | $1,486 |
Destruction of Lesion (outpatient) | $665 | 58% | $279 |
Destruction of Lesions, up to 14 | $675 | 58% | $284 |
Detection test for Human Papillomavirus (HPV) | $188 | 58% | $79 |
Emergency Department Visit - Low Complexity (outpatient) | $672 | 58% | $282 |
Emergency Department Visit - Minor (outpatient) | $473 | 58% | $198 |
Emergency Department Visit - Moderate Complexity (outpatient) | $1,040 | 58% | $437 |
Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $149 | 58% | $63 |
Fetal Non-Stress Test | $960 | 58% | $403 |
Hernia Repair - Laparoscopic (outpatient) | $35,565 | 58% | $14,937 |
Lab Test - Detection test for Hepatitis B Surface Antigen | $190 | 58% | $80 |
Lab Test - Detection test for HIV-1 and HIV-2 | $188 | 58% | $79 |
Lab Test - Smear for Microorganism | $109 | 58% | $46 |
Mammogram (outpatient) | $920 | 58% | $386 |
MRI - Back (outpatient) | $4,960 | 58% | $2,083 |
MRI - Brain (outpatient) | $6,902 | 58% | $2,899 |
MRI - Knee (outpatient) | $3,945 | 58% | $1,657 |
MRI - Pelvis (outpatient) | $7,053 | 58% | $2,962 |
MRI - Shoulder, Elbow, or Wrist | $5,066 | 58% | $2,128 |
Myocardial Imaging (outpatient) | $8,924 | 58% | $3,748 |
Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $516 | 58% | $217 |
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $387 | 58% | $163 |
Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $422 | 58% | $177 |
Office Visit - Established Patient, Moderate Complexity | $357 | 58% | $150 |
Pap Test | $236 | 58% | $99 |
Physical Therapy - Application of Hot or Cold Pack | $33 | 58% | $14 |
Physical Therapy - Electrical Stimulation Therapy | $79 | 58% | $33 |
Physical Therapy - High Complexity Evaluation | $590 | 58% | $248 |
Physical Therapy - Low Complexity Evaluation | $195 | 58% | $82 |
Physical Therapy - Moderate Complexity Evaluation | $342 | 58% | $144 |
Physical Therapy - Therapeutic Activities | $95 | 58% | $40 |
Physical Therapy - Therapeutic Exercises | $95 | 58% | $40 |
Physical Therapy - Ultrasound Therapy | $81 | 58% | $34 |
Strep Test (Streptococcus, group A) | $99 | 58% | $41 |
Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $191 | 58% | $80 |
Tonsillectomy with Adenoidectomy (outpatient) | $13,270 | 58% | $5,574 |
Ultrasound - Abdominal, Complete | $1,556 | 58% | $654 |
Ultrasound - Abdominal, Limited | $1,326 | 58% | $557 |
Ultrasound - Breast (outpatient) | $1,748 | 58% | $734 |
Ultrasound - Head and Neck | $1,546 | 58% | $649 |
Ultrasound - Pelvic (outpatient) | $1,329 | 58% | $558 |
Ultrasound - Pregnancy (outpatient) | $1,504 | 58% | $632 |
Ultrasound - Pregnancy Follow-Up | $927 | 58% | $389 |
Ultrasound - Transvaginal (non-maternity) | $1,326 | 58% | $557 |
Upper Gastrointestinal Endoscopy - Diagnostic | $6,782 | 58% | $2,849 |
Upper Gastrointestinal Endoscopy - With Biopsy | $8,567 | 58% | $3,598 |
Urine Capacity Measurement | $932 | 58% | $391 |
Urine Test - Automated with Microscope Examination | $171 | 58% | $72 |
Urine Test - Automated without Microscope | $191 | 58% | $80 |
Urine Test - Bacterial Culture, Quantitative Colony Count | $87 | 58% | $37 |
Urine Test - Chlamydia | $158 | 58% | $66 |
Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $158 | 58% | $66 |
Urine Test - Microalbumin (Protein) Level | $69 | 58% | $29 |
Urine Test - Pregnancy | $60 | 58% | $25 |
Urine Test - Urinalysis, Manual Test | $55 | 58% | $23 |
Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $141 | 58% | $59 |
X-Ray - Abdomen | $1,038 | 58% | $436 |
X-Ray - Ankle (outpatient) | $666 | 58% | $280 |
X-Ray - Chest (outpatient) | $870 | 58% | $366 |
X-Ray - Foot (outpatient) | $769 | 58% | $323 |
X-Ray - Hand | $965 | 58% | $405 |
X-Ray - Hip | $887 | 58% | $373 |
X-Ray - Knee (outpatient) | $929 | 58% | $390 |
X-Ray - Middle Back, Thoracic Spine | $950 | 58% | $399 |
X-Ray - Neck, Cervical Spine | $844 | 58% | $355 |
X-Ray - Pelvis | $729 | 58% | $306 |
X-Ray - Shoulder (outpatient) | $863 | 58% | $363 |
X-Ray - Spine (outpatient) | $1,036 | 58% | $435 |
X-Ray - Wrist (outpatient) | $834 | 58% | $350 |