| Arthrocentesis (outpatient) | $533 | 0% | $533 | 
Medium |
| Bacterial Culture Swab | $59 | 0% | $59 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,095 | 0% | $1,095 |
Medium |
| Blood Test - Basic Metabolic Panel | $45 | 0% | $45 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $29 | 0% | $29 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $45 | 0% | $45 |
Medium |
| Blood Test - Clotting Time | $18 | 0% | $18 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $39 | 0% | $39 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $47 | 0% | $47 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $47 | 0% | $47 |
Medium |
| Blood Test - Electrolytes Panel | $29 | 0% | $29 |
Medium |
| Blood Test - Folic Acid Level | $50 | 0% | $50 |
Medium |
| Blood Test - General Health Panel | $156 | 0% | $156 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $31 | 0% | $31 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $39 | 0% | $39 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $24 | 0% | $24 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $105 | 0% | $105 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $62 | 0% | $62 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $63 | 0% | $63 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $50 | 0% | $50 |
Medium |
| Blood Test - Vitamin D-3 Level | $107 | 0% | $107 |
Medium |
| Bone Density Scan (outpatient) | $447 | 0% | $447 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $3,843 | 0% | $3,843 | 
High |
| Colonoscopy - With Biopsy (outpatient) | $4,772 | 0% | $4,772 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,129 | 0% | $5,129 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $1,463 | 0% | $1,463 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,376 | 0% | $1,376 |
Medium |
| CT Scan - Head/Brain, without Contrast | $359 | 0% | $359 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $87 | 0% | $87 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $483 | 0% | $483 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $350 | 0% | $350 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $723 | 0% | $723 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $58 | 0% | $58 |
Medium |
| Fetal Non-Stress Test | $721 | 0% | $721 |
Medium |
| Kidney Stone Removal (outpatient) | $9,950 | 0% | $9,950 |
Medium |
| Mammogram (outpatient) | $601 | 0% | $601 |
Medium |
| MRI - Back (outpatient) | $920 | 0% | $920 |
Medium |
| MRI - Brain (outpatient) | $1,999 | 0% | $1,999 |
Medium |
| MRI - Knee (outpatient) | $920 | 0% | $920 |
High |
| MRI - Pelvis (outpatient) | $1,462 | 0% | $1,462 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $1,166 | 0% | $1,166 |
Medium |
| Myocardial Imaging (outpatient) | $5,776 | 0% | $5,776 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,212 | 0% | $1,212 |
Medium |
| Office Visit - Basic | $147 | 0% | $147 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $369 | 0% | $369 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $383 | 0% | $383 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $407 | 0% | $407 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $354 | 0% | $354 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $326 | 0% | $326 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $357 | 0% | $357 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $332 | 0% | $332 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $361 | 0% | $361 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $326 | 0% | $326 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $305 | 0% | $305 |
Medium |
| Office Visit - Established Patient, High Complexity | $470 | 0% | $470 |
Medium |
| Office Visit - Established Patient, Low Complexity | $226 | 0% | $226 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $336 | 0% | $336 |
Medium |
| Office Visit - New Patient, Low Complexity | $350 | 0% | $350 |
Medium |
| Pap Test | $126 | 0% | $126 |
Medium |
| Physical Therapy - High Complexity Evaluation | $288 | 0% | $288 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $217 | 0% | $217 |
Medium |
| Physical Therapy - Manual Therapy | $96 | 0% | $96 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $94 | 0% | $94 |
Medium |
| Physical Therapy - Therapeutic Activities | $89 | 0% | $89 |
Medium |
| Physical Therapy - Therapeutic Exercises | $97 | 0% | $97 |
Medium |
| Physical Therapy - Ultrasound Therapy | $96 | 0% | $96 |
Medium |
| Strep Test (Streptococcus, group A) | $38 | 0% | $38 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $36 | 0% | $36 |
Medium |
| Ultrasound - Abdominal, Complete | $740 | 0% | $740 |
Medium |
| Ultrasound - Abdominal, Limited | $510 | 0% | $510 |
Medium |
| Ultrasound - Breast (outpatient) | $1,050 | 0% | $1,050 |
Medium |
| Ultrasound - Head and Neck | $708 | 0% | $708 |
Medium |
| Ultrasound - Pelvic (outpatient) | $614 | 0% | $614 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $838 | 0% | $838 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $656 | 0% | $656 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $572 | 0% | $572 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,330 | 0% | $5,330 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,181 | 0% | $5,181 |
Medium |
| Urine Test - Automated with Microscope Examination | $18 | 0% | $18 |
Medium |
| Urine Test - Automated without Microscope | $25 | 0% | $25 |
Medium |
| Urine Test - Bacterial Culture | $30 | 0% | $30 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $36 | 0% | $36 |
Medium |
| Urine Test - Chlamydia | $87 | 0% | $87 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $87 | 0% | $87 |
Medium |
| Urine Test - Pregnancy | $24 | 0% | $24 |
Medium |
| X-Ray - Abdomen | $301 | 0% | $301 |
Medium |
| X-Ray - Ankle (outpatient) | $313 | 0% | $313 |
Medium |
| X-Ray - Chest (outpatient) | $479 | 0% | $479 |
High |
| X-Ray - Foot (outpatient) | $403 | 0% | $403 |
Medium |
| X-Ray - Hand | $626 | 0% | $626 |
Medium |
| X-Ray - Hip | $657 | 0% | $657 |
Medium |
| X-Ray - Knee (outpatient) | $442 | 0% | $442 |
High |
| X-Ray - Neck, Cervical Spine | $574 | 0% | $574 |
Medium |
| X-Ray - Shoulder (outpatient) | $494 | 0% | $494 |
High |
| X-Ray - Spine (outpatient) | $530 | 0% | $530 |
Medium |
| X-Ray - Wrist (outpatient) | $397 | 0% | $397 |
Medium |
