| Arthrocentesis (outpatient) | $721 | 0% | $721 | 
Low |
| Bacterial Culture Swab | $74 | 0% | $74 | 
Medium |
| Biopsy - Breast | $5,005 | 0% | $5,005 | 
High |
| Biopsy - Endometrial (Uterus) | $1,109 | 0% | $1,109 |
Medium |
| Blood Test - Basic Metabolic Panel | $75 | 0% | $75 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $42 | 0% | $42 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | 0% | $111 |
Medium |
| Blood Test - Clotting Time | $25 | 0% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $68 | 0% | $68 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $102 | 0% | $102 |
Medium |
| Blood Test - Folic Acid Level | $65 | 0% | $65 |
Medium |
| Blood Test - General Health Panel | $244 | 0% | $244 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $105 | 0% | $105 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $98 | 0% | $98 |
Medium |
| Blood Test - LDL Cholesterol Level | $70 | 0% | $70 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $65 | 0% | $65 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $461 | 0% | $461 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $91 | 0% | $91 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $68 | 0% | $68 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $74 | 0% | $74 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $72 | 0% | $72 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $74 | 0% | $74 |
Medium |
| Blood Test - Vitamin D-3 Level | $145 | 0% | $145 |
Medium |
| Bone Density Scan (outpatient) | $477 | 0% | $477 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,249 | 0% | $4,249 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $4,725 | 0% | $4,725 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $5,142 | 0% | $5,142 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,953 | 0% | $2,953 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $1,798 | 0% | $1,798 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,251 | 0% | $1,251 |
Medium |
| Destruction of Lesion (outpatient) | $476 | 0% | $476 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $130 | 0% | $130 |
Medium |
| Electrocardiogram (ECG or EKG) | $530 | 0% | $530 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $216 | 0% | $216 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $116 | 0% | $116 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $390 | 0% | $390 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $68 | 0% | $68 |
Medium |
| Fetal Non-Stress Test | $677 | 0% | $677 |
Medium |
| Mammogram (outpatient) | $830 | 0% | $830 |
Medium |
| MRI - Back (outpatient) | $2,600 | 0% | $2,600 |
Medium |
| MRI - Brain (outpatient) | $5,310 | 0% | $5,310 |
High |
| MRI - Knee (outpatient) | $1,944 | 0% | $1,944 |
Medium |
| Myocardial Imaging (outpatient) | $5,471 | 0% | $5,471 |
Medium |
| Office Visit - Basic | $140 | 0% | $140 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $216 | 0% | $216 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $239 | 0% | $239 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 0% | $232 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $271 | 0% | $271 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $224 | 0% | $224 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $201 | 0% | $201 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $184 | 0% | $184 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $206 | 0% | $206 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $206 | 0% | $206 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $259 | 0% | $259 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $184 | 0% | $184 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $168 | 0% | $168 |
Medium |
| Office Visit - Established Patient, High Complexity | $336 | 0% | $336 |
Medium |
| Office Visit - Established Patient, Low Complexity | $215 | 0% | $215 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $247 | 0% | $247 |
Medium |
| Office Visit - New Patient, Low Complexity | $244 | 0% | $244 |
Medium |
| Office Visit - New Patient, Minor | $235 | 0% | $235 |
Medium |
| Pap Test | $128 | 0% | $128 |
Medium |
| Physical Therapy - High Complexity Evaluation | $254 | 0% | $254 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $254 | 0% | $254 |
Medium |
| Physical Therapy - Manual Therapy | $71 | 0% | $71 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $254 | 0% | $254 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $71 | 0% | $71 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $71 | 0% | $71 |
Medium |
| Physical Therapy - Therapeutic Activities | $68 | 0% | $68 |
Medium |
| Physical Therapy - Therapeutic Exercises | $71 | 0% | $71 |
Medium |
| Physical Therapy - Ultrasound Therapy | $71 | 0% | $71 |
Medium |
| Psychiatric Diagnostic Evaluation | $209 | 0% | $209 |
Medium |
| Psychotherapy - 30 Minutes | $69 | 0% | $69 |
Medium |
| Psychotherapy - 45 Minutes | $104 | 0% | $104 |
Medium |
| Psychotherapy - Group Session | $62 | 0% | $62 |
Medium |
| Strep Test (Streptococcus, group A) | $60 | 0% | $60 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $58 | 0% | $58 |
Medium |
| Ultrasound - Abdominal, Complete | $677 | 0% | $677 |
Medium |
| Ultrasound - Abdominal, Limited | $521 | 0% | $521 |
Medium |
| Ultrasound - Breast (outpatient) | $1,230 | 0% | $1,230 |
Medium |
| Ultrasound - Head and Neck | $685 | 0% | $685 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $768 | 0% | $768 |
High |
| Ultrasound - Pregnancy Follow-Up | $729 | 0% | $729 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $698 | 0% | $698 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,358 | 0% | $5,358 |
Medium |
| Urine Test - Automated with Microscope Examination | $42 | 0% | $42 |
Medium |
| Urine Test - Automated without Microscope | $32 | 0% | $32 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $46 | 0% | $46 |
Medium |
| Urine Test - Chlamydia | $151 | 0% | $151 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $151 | 0% | $151 |
Medium |
| Urine Test - Pregnancy | $35 | 0% | $35 |
Medium |
| X-Ray - Abdomen | $501 | 0% | $501 |
Medium |
| X-Ray - Ankle (outpatient) | $436 | 0% | $436 |
Medium |
| X-Ray - Chest (outpatient) | $479 | 0% | $479 |
Medium |
| X-Ray - Foot (outpatient) | $458 | 0% | $458 |
High |
| X-Ray - Hand | $454 | 0% | $454 |
Medium |
| X-Ray - Hip | $554 | 0% | $554 |
Medium |
| X-Ray - Knee (outpatient) | $476 | 0% | $476 |
Medium |
| X-Ray - Neck, Cervical Spine | $480 | 0% | $480 |
Medium |
| X-Ray - Pelvis | $575 | 0% | $575 |
Medium |
| X-Ray - Shoulder (outpatient) | $579 | 0% | $579 |
Medium |
| X-Ray - Spine (outpatient) | $590 | 0% | $590 |
Medium |
| X-Ray - Wrist (outpatient) | $470 | 0% | $470 |
Medium |
