| Arthrocentesis (outpatient) | $975 | 0% | $975 | 
High |
| Bacterial Culture Swab | $95 | 0% | $95 | 
Medium |
| Blood Test - Basic Metabolic Panel | $98 | 0% | $98 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $98 | 0% | $98 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $100 | 0% | $100 |
Medium |
| Blood Test - Clotting Time | $46 | 0% | $46 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $77 | 0% | $77 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $93 | 0% | $93 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $77 | 0% | $77 |
Medium |
| Blood Test - Electrolytes Panel | $78 | 0% | $78 |
Medium |
| Blood Test - Folic Acid Level | $60 | 0% | $60 |
Medium |
| Blood Test - General Health Panel | $267 | 0% | $267 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $166 | 0% | $166 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $48 | 0% | $48 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $67 | 0% | $67 |
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 | $100 | 0% | $100 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $114 | 0% | $114 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $62 | 0% | $62 |
Medium |
| Blood Test - Vitamin D-3 Level | $122 | 0% | $122 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,015 | 0% | $4,015 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,376 | 0% | $5,376 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,573 | 0% | $5,573 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,692 | 0% | $3,692 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,575 | 0% | $1,575 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $101 | 0% | $101 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $331 | 0% | $331 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $311 | 0% | $311 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $618 | 0% | $618 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $63 | 0% | $63 |
Medium |
| Mammogram (outpatient) | $639 | 0% | $639 |
Medium |
| MRI - Brain (outpatient) | $3,296 | 0% | $3,296 |
Medium |
| MRI - Knee (outpatient) | $1,642 | 0% | $1,642 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,172 | 0% | $2,172 |
Medium |
| Myocardial Imaging (outpatient) | $5,608 | 0% | $5,608 |
Medium |
| Office Visit - Basic | $75 | 0% | $75 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $214 | 0% | $214 |
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 | $235 | 0% | $235 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $257 | 0% | $257 |
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 | $192 | 0% | $192 |
Medium |
| Office Visit - Established Patient, High Complexity | $235 | 0% | $235 |
Medium |
| Office Visit - Established Patient, Low Complexity | $119 | 0% | $119 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $174 | 0% | $174 |
Medium |
| Office Visit - New Patient, Low Complexity | $163 | 0% | $163 |
Medium |
| Office Visit - New Patient, Minor | $164 | 0% | $164 |
Medium |
| Pap Test | $125 | 0% | $125 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $166 | 0% | $166 |
Medium |
| Physical Therapy - Manual Therapy | $81 | 0% | $81 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $234 | 0% | $234 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $79 | 0% | $79 |
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) | $42 | 0% | $42 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $74 | 0% | $74 |
Medium |
| Ultrasound - Abdominal, Limited | $1,052 | 0% | $1,052 |
Medium |
| Ultrasound - Breast (outpatient) | $1,502 | 0% | $1,502 |
High |
| Ultrasound - Head and Neck | $1,042 | 0% | $1,042 |
High |
| Ultrasound - Pregnancy (outpatient) | $1,279 | 0% | $1,279 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,347 | 0% | $1,347 |
Medium |
| Urine Test - Automated without Microscope | $26 | 0% | $26 |
Medium |
| Urine Test - Bacterial Culture | $49 | 0% | $49 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $40 | 0% | $40 |
Medium |
| Urine Test - Chlamydia | $95 | 0% | $95 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $95 | 0% | $95 |
Medium |
| Urine Test - Pregnancy | $70 | 0% | $70 |
Medium |
| X-Ray - Abdomen | $354 | 0% | $354 |
High |
| X-Ray - Ankle (outpatient) | $448 | 0% | $448 |
Medium |
| X-Ray - Chest (outpatient) | $524 | 0% | $524 |
Medium |
| X-Ray - Foot (outpatient) | $734 | 0% | $734 |
Medium |
| X-Ray - Hand | $469 | 0% | $469 |
Medium |
| X-Ray - Hip | $466 | 0% | $466 |
Medium |
| X-Ray - Knee (outpatient) | $496 | 0% | $496 |
Medium |
| X-Ray - Shoulder (outpatient) | $418 | 0% | $418 |
Medium |
| X-Ray - Wrist (outpatient) | $647 | 0% | $647 |
Medium |
