| Arthrocentesis (outpatient) | $819 | 0% | $819 | 
High |
| Blood Test - Basic Metabolic Panel | $92 | 0% | $92 | 
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $98 | 0% | $98 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $139 | 0% | $139 |
Medium |
| Blood Test - Clotting Time | $46 | 0% | $46 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $72 | 0% | $72 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $88 | 0% | $88 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $113 | 0% | $113 |
Medium |
| Blood Test - Electrolytes Panel | $76 | 0% | $76 |
Medium |
| Blood Test - General Health Panel | $334 | 0% | $334 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $158 | 0% | $158 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $45 | 0% | $45 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $195 | 0% | $195 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $139 | 0% | $139 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $108 | 0% | $108 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $59 | 0% | $59 |
Medium |
| Blood Test - Vitamin D-3 Level | $75 | 0% | $75 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $3,992 | 0% | $3,992 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $4,551 | 0% | $4,551 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,688 | 0% | $3,688 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,573 | 0% | $1,573 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $331 | 0% | $331 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $295 | 0% | $295 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $600 | 0% | $600 |
Medium |
| Mammogram (outpatient) | $614 | 0% | $614 |
Medium |
| MRI - Knee (outpatient) | $1,642 | 0% | $1,642 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,172 | 0% | $2,172 |
Medium |
| Myocardial Imaging (outpatient) | $4,873 | 0% | $4,873 |
Medium |
| Office Visit - Basic | $71 | 0% | $71 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $204 | 0% | $204 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $223 | 0% | $223 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $224 | 0% | $224 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $245 | 0% | $245 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $203 | 0% | $203 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $183 | 0% | $183 |
Medium |
| Office Visit - Established Patient, High Complexity | $213 | 0% | $213 |
Medium |
| Office Visit - Established Patient, Low Complexity | $106 | 0% | $106 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $161 | 0% | $161 |
Medium |
| Office Visit - New Patient, Low Complexity | $163 | 0% | $163 |
Medium |
| Office Visit - New Patient, Minor | $152 | 0% | $152 |
Medium |
| Physical Therapy - High Complexity Evaluation | $291 | 0% | $291 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $158 | 0% | $158 |
Medium |
| Physical Therapy - Manual Therapy | $81 | 0% | $81 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $234 | 0% | $234 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $76 | 0% | $76 |
Medium |
| Physical Therapy - Therapeutic Exercises | $81 | 0% | $81 |
Medium |
| Physical Therapy - Ultrasound Therapy | $70 | 0% | $70 |
Medium |
| Psychiatric Diagnostic Evaluation | $194 | 0% | $194 |
Medium |
| Psychotherapy - 30 Minutes | $80 | 0% | $80 |
Medium |
| Psychotherapy - 45 Minutes | $109 | 0% | $109 |
Medium |
| Psychotherapy - 60 Minutes | $151 | 0% | $151 |
Medium |
| Psychotherapy - Group Session | $196 | 0% | $196 |
Medium |
| Strep Test (Streptococcus, group A) | $40 | 0% | $40 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $69 | 0% | $69 |
Medium |
| Ultrasound - Abdominal, Limited | $1,029 | 0% | $1,029 |
Medium |
| Ultrasound - Head and Neck | $1,019 | 0% | $1,019 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $1,253 | 0% | $1,253 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,347 | 0% | $1,347 |
Medium |
| Urine Test - Automated without Microscope | $26 | 0% | $26 |
Medium |
| Urine Test - Bacterial Culture | $38 | 0% | $38 |
Medium |
| Urine Test - Chlamydia | $95 | 0% | $95 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $95 | 0% | $95 |
Medium |
| Urine Test - Pregnancy | $66 | 0% | $66 |
Medium |
| X-Ray - Abdomen | $337 | 0% | $337 |
Medium |
| X-Ray - Ankle (outpatient) | $377 | 0% | $377 |
Medium |
| X-Ray - Chest (outpatient) | $576 | 0% | $576 |
High |
| X-Ray - Foot (outpatient) | $561 | 0% | $561 |
Medium |
| X-Ray - Hand | $390 | 0% | $390 |
Medium |
| X-Ray - Hip | $621 | 0% | $621 |
Medium |
| X-Ray - Knee (outpatient) | $485 | 0% | $485 |
High |
| X-Ray - Shoulder (outpatient) | $497 | 0% | $497 |
Medium |
| X-Ray - Wrist (outpatient) | $537 | 0% | $537 |
Medium |
