| Arthrocentesis (outpatient) | $668 | 0% | $668 | 
Medium |
| Arthroscopic Knee Surgery (outpatient) | $15,773 | 0% | $15,773 | 
High |
| Biopsy - Breast | $6,839 | 0% | $6,839 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,103 | 0% | $1,103 |
Medium |
| Blood Test - Basic Metabolic Panel | $45 | 0% | $45 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $38 | 0% | $38 |
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 - General Health Panel | $156 | 0% | $156 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $31 | 0% | $31 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $105 | 0% | $105 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $43 | 0% | $43 |
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) | $318 | 0% | $318 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,177 | 0% | $4,177 |
High |
| Colonoscopy - With Biopsy (outpatient) | $4,980 | 0% | $4,980 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,245 | 0% | $5,245 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $1,471 | 0% | $1,471 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,271 | 0% | $1,271 |
Medium |
| CT Scan - Head/Brain, without Contrast | $742 | 0% | $742 |
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 |
| Fetal Non-Stress Test | $714 | 0% | $714 |
Medium |
| Gall Bladder Surgery (outpatient) | $14,691 | 0% | $14,691 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $12,064 | 0% | $12,064 |
High |
| Kidney Stone Removal (outpatient) | $11,108 | 0% | $11,108 |
Medium |
| Mammogram (outpatient) | $645 | 0% | $645 |
Medium |
| MRI - Back (outpatient) | $1,198 | 0% | $1,198 |
Medium |
| MRI - Brain (outpatient) | $2,008 | 0% | $2,008 |
Medium |
| MRI - Knee (outpatient) | $1,161 | 0% | $1,161 |
High |
| MRI - Pelvis (outpatient) | $1,848 | 0% | $1,848 |
High |
| MRI - Shoulder, Elbow, or Wrist | $1,176 | 0% | $1,176 |
Medium |
| Myocardial Imaging (outpatient) | $5,602 | 0% | $5,602 |
Medium |
| Nasal Endoscopy - Diagnostic | $1,227 | 0% | $1,227 |
Medium |
| Office Visit - Basic | $143 | 0% | $143 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $284 | 0% | $284 |
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 | $462 | 0% | $462 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $354 | 0% | $354 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $231 | 0% | $231 |
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 | $441 | 0% | $441 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $199 | 0% | $199 |
Medium |
| Office Visit - New Patient, Low Complexity | $273 | 0% | $273 |
Medium |
| Office Visit - New Patient, Minor | $236 | 0% | $236 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $217 | 0% | $217 |
Medium |
| Physical Therapy - Manual Therapy | $96 | 0% | $96 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $228 | 0% | $228 |
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) | $1,090 | 0% | $1,090 |
Medium |
| Ultrasound - Head and Neck | $714 | 0% | $714 |
Medium |
| Ultrasound - Pelvic (outpatient) | $553 | 0% | $553 |
High |
| Ultrasound - Pregnancy (outpatient) | $838 | 0% | $838 | 
Low |
| Ultrasound - Pregnancy Follow-Up | $656 | 0% | $656 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $572 | 0% | $572 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $2,994 | 0% | $2,994 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,178 | 0% | $5,178 |
Medium |
| Urine Test - Automated with Microscope Examination | $18 | 0% | $18 |
Medium |
| Urine Test - Automated without Microscope | $25 | 0% | $25 |
Medium |
| Urine Test - Bacterial Culture | $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 | $409 | 0% | $409 |
Medium |
| X-Ray - Ankle (outpatient) | $286 | 0% | $286 |
High |
| X-Ray - Chest (outpatient) | $478 | 0% | $478 |
High |
| X-Ray - Foot (outpatient) | $364 | 0% | $364 |
Medium |
| X-Ray - Hand | $414 | 0% | $414 |
Medium |
| X-Ray - Hip | $744 | 0% | $744 |
Medium |
| X-Ray - Knee (outpatient) | $459 | 0% | $459 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $900 | 0% | $900 |
High |
| X-Ray - Neck, Cervical Spine | $543 | 0% | $543 |
Medium |
| X-Ray - Shoulder (outpatient) | $371 | 0% | $371 |
Medium |
| X-Ray - Spine (outpatient) | $442 | 0% | $442 |
Medium |
| X-Ray - Wrist (outpatient) | $340 | 0% | $340 |
Medium |
