| Arthrocentesis (outpatient) | $1,102 | 0% | $1,102 | 
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $69 | 0% | $69 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $122 | 0% | $122 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $50 | 0% | $50 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $98 | 0% | $98 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $192 | 0% | $192 |
Medium |
| Blood Test - General Health Panel | $190 | 0% | $190 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $141 | 0% | $141 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $160 | 0% | $160 |
Medium |
| Bone Density Scan (outpatient) | $322 | 0% | $322 |
Medium |
| Destruction of Lesion (outpatient) | $541 | 0% | $541 |
Medium |
| Mammogram (outpatient) | $683 | 0% | $683 |
Medium |
| Office Visit - Basic | $141 | 0% | $141 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $349 | 0% | $349 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $302 | 0% | $302 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $367 | 0% | $367 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $344 | 0% | $344 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $258 | 0% | $258 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 0% | $281 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $315 | 0% | $315 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $253 | 0% | $253 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $264 | 0% | $264 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $281 | 0% | $281 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $270 | 0% | $270 |
Medium |
| Office Visit - Established Patient, High Complexity | $239 | 0% | $239 |
Medium |
| Office Visit - Established Patient, Low Complexity | $176 | 0% | $176 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $209 | 0% | $209 |
Medium |
| Office Visit - New Patient, Low Complexity | $245 | 0% | $245 |
Medium |
| Office Visit - New Patient, Minor | $169 | 0% | $169 |
Medium |
| Pap Test | $166 | 0% | $166 |
Medium |
| Strep Test (Streptococcus, group A) | $44 | 0% | $44 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $639 | 0% | $639 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $284 | 0% | $284 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,089 | 0% | $1,089 |
Medium |
| Urine Test - Automated with Microscope Examination | $35 | 0% | $35 |
Medium |
| Urine Test - Automated without Microscope | $3 | 0% | $3 |
Medium |
| Urine Test - Pregnancy | $53 | 0% | $53 |
Medium |
| X-Ray - Chest (outpatient) | $632 | 0% | $632 | 
High |
