| Arthrocentesis (outpatient) | $1,548 | 89% | $170 | 
Medium |
| Bacterial Culture Swab | $164 | 89% | $18 |
Medium |
| Biopsy - Breast | $10,917 | 89% | $1,201 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $127 | 89% | $14 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $205 | 89% | $23 |
Medium |
| Blood Test - Folic Acid Level | $168 | 89% | $18 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $139 | 89% | $15 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $190 | 89% | $21 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $142 | 89% | $16 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $162 | 89% | $18 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 89% | $9 |
Medium |
| Bone Density Scan (outpatient) | $1,074 | 89% | $118 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,740 | 89% | $521 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $6,118 | 89% | $673 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $6,339 | 89% | $697 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,174 | 89% | $569 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $4,629 | 89% | $509 |
Medium |
| Cystoscopy | $2,333 | 89% | $257 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $194 | 89% | $21 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $1,227 | 89% | $135 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $699 | 89% | $77 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $2,982 | 89% | $328 |
Medium |
| Fetal Non-Stress Test | $1,271 | 89% | $140 |
Medium |
| Laryngoscopy - Diagnostic | $478 | 89% | $53 | 
High |
| Mammogram (outpatient) | $999 | 89% | $110 |
Medium |
| MRI - Back (outpatient) | $5,043 | 89% | $555 |
Medium |
| MRI - Brain (outpatient) | $7,763 | 89% | $854 |
High |
| MRI - Pelvis (outpatient) | $6,578 | 89% | $724 |
Medium |
| Nasal Endoscopy - Diagnostic | $693 | 89% | $76 |
High |
| Office Visit - Basic | $89 | 89% | $10 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $234 | 89% | $26 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $234 | 89% | $26 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $272 | 89% | $30 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $205 | 89% | $23 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $205 | 89% | $23 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $224 | 89% | $25 |
Medium |
| Office Visit - Established Patient, High Complexity | $292 | 89% | $32 |
Medium |
| Office Visit - Established Patient, Low Complexity | $147 | 89% | $16 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $217 | 89% | $24 |
Medium |
| Office Visit - New Patient, Low Complexity | $218 | 89% | $24 |
Medium |
| Office Visit - New Patient, Minor | $151 | 89% | $17 |
Medium |
| Pap Test | $235 | 89% | $26 |
Medium |
| Physical Therapy - High Complexity Evaluation | $547 | 89% | $60 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $162 | 89% | $18 |
Medium |
| Ultrasound - Abdominal, Complete | $1,505 | 89% | $166 |
High |
| Ultrasound - Abdominal, Limited | $1,022 | 89% | $112 |
Medium |
| Ultrasound - Breast (outpatient) | $1,532 | 89% | $169 |
Medium |
| Ultrasound - Head and Neck | $1,170 | 89% | $129 |
High |
| Ultrasound - Pelvic (outpatient) | $1,355 | 89% | $149 |
High |
| Ultrasound - Transvaginal (non-maternity) | $944 | 89% | $104 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,885 | 89% | $647 |
Medium |
| Urine Capacity Measurement | $839 | 89% | $92 |
Medium |
| Urine Test - Automated with Microscope Examination | $125 | 89% | $14 |
Medium |
| Urine Test - Automated without Microscope | $83 | 89% | $9 |
Medium |
| Urine Test - Chlamydia | $156 | 89% | $17 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $156 | 89% | $17 |
Medium |
| Urine Test - Pregnancy | $28 | 89% | $3 |
Medium |
| X-Ray - Abdomen | $559 | 89% | $61 |
High |
| X-Ray - Ankle (outpatient) | $746 | 89% | $82 |
High |
| X-Ray - Chest (outpatient) | $794 | 89% | $87 |
Medium |
| X-Ray - Foot (outpatient) | $877 | 89% | $96 |
Medium |
| X-Ray - Hand | $1,090 | 89% | $120 |
High |
| X-Ray - Hip | $359 | 89% | $40 |
Medium |
| X-Ray - Knee (outpatient) | $855 | 89% | $94 |
High |
| X-Ray - Neck, Cervical Spine | $680 | 89% | $75 |
High |
| X-Ray - Shoulder (outpatient) | $654 | 89% | $72 |
High |
| X-Ray - Spine (outpatient) | $890 | 89% | $98 |
Medium |
| X-Ray - Wrist (outpatient) | $1,010 | 89% | $111 |
Medium |
