| Arthrocentesis (outpatient) | $1,314 | 89% | $145 | 
High |
| Bacterial Culture Swab | $116 | 89% | $13 | 
Medium |
| Biopsy - Breast | $8,057 | 89% | $886 |
Medium |
| Blood Test - Basic Metabolic Panel | $108 | 89% | $12 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $121 | 89% | $13 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $167 | 89% | $18 |
Medium |
| Blood Test - Clotting Time | $52 | 89% | $6 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $89 | 89% | $10 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $133 | 89% | $15 |
Medium |
| Blood Test - Folic Acid Level | $184 | 89% | $20 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $96 | 89% | $11 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $192 | 89% | $21 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $82 | 89% | $9 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $109 | 89% | $12 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $116 | 89% | $13 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $150 | 89% | $16 |
Medium |
| Blood Test - Vitamin D-3 Level | $266 | 89% | $29 |
Medium |
| Bone Density Scan (outpatient) | $891 | 89% | $98 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,858 | 89% | $644 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $8,836 | 89% | $972 |
High |
| Colonoscopy - With Polyp Removal (outpatient) | $9,015 | 89% | $992 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $6,669 | 89% | $734 |
Medium |
| CT Scan - Head/Brain, without Contrast | $3,738 | 89% | $411 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $1,237 | 89% | $136 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $775 | 89% | $85 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,955 | 89% | $215 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $109 | 89% | $12 |
Medium |
| Fetal Non-Stress Test | $2,300 | 89% | $253 |
High |
| Gall Bladder Surgery (outpatient) | $43,460 | 89% | $4,781 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $44,205 | 89% | $4,863 |
Medium |
| Mammogram (outpatient) | $780 | 89% | $86 |
Medium |
| MRI - Back (outpatient) | $4,837 | 89% | $532 |
High |
| MRI - Brain (outpatient) | $6,525 | 89% | $718 |
Medium |
| MRI - Knee (outpatient) | $4,382 | 89% | $482 |
Medium |
| MRI - Pelvis (outpatient) | $6,740 | 89% | $741 |
High |
| MRI - Shoulder, Elbow, or Wrist | $4,382 | 89% | $482 |
Medium |
| Myocardial Imaging (outpatient) | $8,016 | 89% | $882 |
Medium |
| Office Visit - Basic | $95 | 89% | $10 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $315 | 89% | $35 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $336 | 89% | $37 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $273 | 89% | $30 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $294 | 89% | $32 |
Medium |
| Office Visit - Established Patient, High Complexity | $331 | 89% | $36 |
Medium |
| Office Visit - Established Patient, Low Complexity | $163 | 89% | $18 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $226 | 89% | $25 |
Medium |
| Physical Therapy - Application of Mechanical Traction | $62 | 89% | $7 |
Medium |
| Physical Therapy - High Complexity Evaluation | $452 | 89% | $50 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $452 | 89% | $50 |
Medium |
| Physical Therapy - Manual Therapy | $152 | 89% | $17 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $452 | 89% | $50 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $152 | 89% | $17 |
Medium |
| Physical Therapy - Therapeutic Activities | $92 | 89% | $10 |
Medium |
| Physical Therapy - Therapeutic Exercises | $152 | 89% | $17 |
Medium |
| Physical Therapy - Therapeutic Massage | $16 | 89% | $2 |
Medium |
| Physical Therapy - Ultrasound Therapy | $65 | 89% | $7 |
Medium |
| Strep Test (Streptococcus, group A) | $67 | 89% | $7 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $81 | 89% | $9 |
Medium |
| Ultrasound - Abdominal, Complete | $1,567 | 89% | $172 |
Medium |
| Ultrasound - Abdominal, Limited | $569 | 89% | $63 |
Medium |
| Ultrasound - Breast (outpatient) | $1,641 | 89% | $181 |
Medium |
| Ultrasound - Head and Neck | $1,218 | 89% | $134 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $616 | 89% | $68 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $485 | 89% | $53 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,293 | 89% | $142 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $7,147 | 89% | $786 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $10,106 | 89% | $1,112 |
Medium |
| Urine Test - Automated with Microscope Examination | $143 | 89% | $16 |
Medium |
| Urine Test - Automated without Microscope | $115 | 89% | $13 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $84 | 89% | $9 |
Medium |
| Urine Test - Chlamydia | $146 | 89% | $16 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $146 | 89% | $16 |
Medium |
| Urine Test - Pregnancy | $143 | 89% | $16 |
Medium |
| X-Ray - Abdomen | $457 | 89% | $50 |
Medium |
| X-Ray - Ankle (outpatient) | $810 | 89% | $89 |
Medium |
| X-Ray - Chest (outpatient) | $387 | 89% | $43 |
High |
| X-Ray - Foot (outpatient) | $804 | 89% | $88 |
High |
| X-Ray - Hand | $736 | 89% | $81 |
Medium |
| X-Ray - Hip | $685 | 89% | $75 |
Medium |
| X-Ray - Knee (outpatient) | $491 | 89% | $54 |
Medium |
| X-Ray - Neck, Cervical Spine | $783 | 89% | $86 |
Medium |
| X-Ray - Shoulder (outpatient) | $634 | 89% | $70 |
Medium |
| X-Ray - Spine (outpatient) | $802 | 89% | $88 |
High |
| X-Ray - Wrist (outpatient) | $731 | 89% | $80 |
Medium |
