| Arthrocentesis (outpatient) | $1,310 | 89% | $157 | 
Medium |
| Biopsy - Breast | $8,641 | 89% | $1,037 | 
High |
| Blood Test - Clotting Time | $83 | 89% | $10 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $127 | 89% | $15 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $190 | 89% | $23 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $128 | 89% | $15 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $162 | 89% | $19 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $189 | 89% | $23 |
Medium |
| Bone Density Scan (outpatient) | $1,074 | 89% | $129 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,663 | 89% | $560 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,588 | 89% | $671 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $6,056 | 89% | $727 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,817 | 89% | $578 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $4,302 | 89% | $516 |
Medium |
| CT Scan - Head/Brain, without Contrast | $4,190 | 89% | $503 |
Medium |
| Cystoscopy | $1,927 | 89% | $231 |
High |
| Emergency Department Visit - Low Complexity (outpatient) | $1,227 | 89% | $147 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $635 | 89% | $76 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $2,711 | 89% | $325 |
Medium |
| Fetal Non-Stress Test | $1,184 | 89% | $142 |
Medium |
| Gall Bladder Surgery (outpatient) | $36,403 | 89% | $4,368 |
High |
| Hernia Repair - Laparoscopic (outpatient) | $46,387 | 89% | $5,566 |
Medium |
| Mammogram (outpatient) | $953 | 89% | $114 |
Medium |
| MRI - Back (outpatient) | $4,987 | 89% | $598 |
Medium |
| MRI - Brain (outpatient) | $7,573 | 89% | $909 |
Medium |
| MRI - Pelvis (outpatient) | $6,298 | 89% | $756 |
Medium |
| Office Visit - Basic | $89 | 89% | $11 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $234 | 89% | $28 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $272 | 89% | $33 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $205 | 89% | $25 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $205 | 89% | $25 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $224 | 89% | $27 |
Medium |
| Office Visit - Established Patient, Low Complexity | $147 | 89% | $18 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $217 | 89% | $26 |
Medium |
| Office Visit - New Patient, Low Complexity | $218 | 89% | $26 |
Medium |
| Office Visit - New Patient, Minor | $151 | 89% | $18 |
Medium |
| Pap Test | $235 | 89% | $28 |
Medium |
| Physical Therapy - High Complexity Evaluation | $478 | 89% | $57 |
Medium |
| Physical Therapy - Therapeutic Exercises | $164 | 89% | $20 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $162 | 89% | $19 |
Medium |
| Ultrasound - Abdominal, Complete | $1,504 | 89% | $180 |
Medium |
| Ultrasound - Abdominal, Limited | $1,022 | 89% | $123 |
High |
| Ultrasound - Breast (outpatient) | $1,244 | 89% | $149 |
Medium |
| Ultrasound - Head and Neck | $1,170 | 89% | $140 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $1,430 | 89% | $172 |
High |
| Ultrasound - Transvaginal (non-maternity) | $1,030 | 89% | $124 |
High |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,700 | 89% | $684 |
Medium |
| Urine Capacity Measurement | $797 | 89% | $96 |
Medium |
| Urine Test - Automated with Microscope Examination | $125 | 89% | $15 |
Medium |
| Urine Test - Automated without Microscope | $83 | 89% | $10 |
Medium |
| Urine Test - Chlamydia | $214 | 89% | $26 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $214 | 89% | $26 |
Medium |
| Urine Test - Pregnancy | $28 | 89% | $3 |
Medium |
| X-Ray - Abdomen | $758 | 89% | $91 |
High |
| X-Ray - Ankle (outpatient) | $591 | 89% | $71 |
Medium |
| X-Ray - Chest (outpatient) | $845 | 89% | $101 |
Medium |
| X-Ray - Foot (outpatient) | $823 | 89% | $99 |
Medium |
| X-Ray - Hand | $999 | 89% | $120 |
Medium |
| X-Ray - Hip | $533 | 89% | $64 |
Medium |
| X-Ray - Neck, Cervical Spine | $790 | 89% | $95 |
High |
| X-Ray - Shoulder (outpatient) | $704 | 89% | $84 |
Medium |
| X-Ray - Spine (outpatient) | $764 | 89% | $92 |
Medium |
| X-Ray - Wrist (outpatient) | $935 | 89% | $112 |
Medium |
