| Arthrocentesis (outpatient) | $1,461 | 88% | $175 | 
High |
| Biopsy - Breast | $5,185 | 88% | $622 | 
Medium |
| Blood Test - Basic Metabolic Panel | $108 | 88% | $13 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $121 | 88% | $15 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $167 | 88% | $20 |
Medium |
| Blood Test - Clotting Time | $51 | 88% | $6 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $84 | 88% | $10 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $133 | 88% | $16 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $168 | 88% | $20 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $105 | 88% | $13 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $192 | 88% | $23 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $116 | 88% | $14 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $150 | 88% | $18 |
Medium |
| Blood Test - Vitamin D-3 Level | $266 | 88% | $32 |
Medium |
| Bone Density Scan (outpatient) | $864 | 88% | $104 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,719 | 88% | $686 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $8,281 | 88% | $994 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $7,831 | 88% | $940 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $6,217 | 88% | $746 |
Medium |
| CT Scan - Head/Brain, without Contrast | $3,681 | 88% | $442 |
High |
| Cystoscopy | $3,783 | 88% | $454 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $1,125 | 88% | $135 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $705 | 88% | $85 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,955 | 88% | $235 |
Medium |
| Fetal Non-Stress Test | $417 | 88% | $50 |
Medium |
| Gall Bladder Surgery (outpatient) | $40,822 | 88% | $4,899 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $48,942 | 88% | $5,873 |
Medium |
| Mammogram (outpatient) | $780 | 88% | $94 |
Medium |
| MRI - Back (outpatient) | $4,579 | 88% | $549 |
High |
| MRI - Brain (outpatient) | $6,469 | 88% | $776 |
Medium |
| MRI - Knee (outpatient) | $4,382 | 88% | $526 |
Medium |
| MRI - Pelvis (outpatient) | $6,540 | 88% | $785 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $4,382 | 88% | $526 |
Medium |
| Myocardial Imaging (outpatient) | $7,155 | 88% | $859 |
Medium |
| Office Visit - Basic | $95 | 88% | $11 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $315 | 88% | $38 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $336 | 88% | $40 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $273 | 88% | $33 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $294 | 88% | $35 |
Medium |
| Office Visit - Established Patient, High Complexity | $331 | 88% | $40 |
Medium |
| Office Visit - Established Patient, Low Complexity | $163 | 88% | $20 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $226 | 88% | $27 |
Medium |
| Physical Therapy - High Complexity Evaluation | $452 | 88% | $54 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $443 | 88% | $53 |
Medium |
| Physical Therapy - Manual Therapy | $152 | 88% | $18 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $443 | 88% | $53 |
Medium |
| Physical Therapy - Therapeutic Activities | $92 | 88% | $11 |
Medium |
| Physical Therapy - Therapeutic Exercises | $152 | 88% | $18 |
Medium |
| Physical Therapy - Ultrasound Therapy | $62 | 88% | $7 |
Medium |
| Strep Test (Streptococcus, group A) | $67 | 88% | $8 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $81 | 88% | $10 |
Medium |
| Ultrasound - Abdominal, Complete | $1,567 | 88% | $188 |
Medium |
| Ultrasound - Abdominal, Limited | $543 | 88% | $65 |
Medium |
| Ultrasound - Breast (outpatient) | $1,641 | 88% | $197 |
Medium |
| Ultrasound - Head and Neck | $1,156 | 88% | $139 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $616 | 88% | $74 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $479 | 88% | $57 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,293 | 88% | $155 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,831 | 88% | $700 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $9,615 | 88% | $1,154 |
Medium |
| Urine Capacity Measurement | $262 | 88% | $31 |
Medium |
| Urine Test - Automated with Microscope Examination | $143 | 88% | $17 |
Medium |
| Urine Test - Automated without Microscope | $115 | 88% | $14 |
Medium |
| Urine Test - Bacterial Culture | $84 | 88% | $10 |
Medium |
| Urine Test - Chlamydia | $127 | 88% | $15 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $127 | 88% | $15 |
Medium |
| Urine Test - Pregnancy | $143 | 88% | $17 |
Medium |
| X-Ray - Abdomen | $376 | 88% | $45 |
High |
| X-Ray - Ankle (outpatient) | $704 | 88% | $84 |
Medium |
| X-Ray - Chest (outpatient) | $430 | 88% | $52 |
High |
| X-Ray - Foot (outpatient) | $797 | 88% | $96 |
High |
| X-Ray - Hand | $664 | 88% | $80 |
Medium |
| X-Ray - Hip | $716 | 88% | $86 |
High |
| X-Ray - Knee (outpatient) | $492 | 88% | $59 |
High |
| X-Ray - Neck, Cervical Spine | $728 | 88% | $87 |
High |
| X-Ray - Shoulder (outpatient) | $620 | 88% | $74 |
Medium |
| X-Ray - Spine (outpatient) | $745 | 88% | $89 |
Medium |
| X-Ray - Wrist (outpatient) | $767 | 88% | $92 |
Medium |
