| Abdominal Hysterectomy | $15,095$72$25k | $25,031 | $25,031 |
| ACL Reconstruction (Arthroscopic) | $4,777$72$14k | $4,777 | $4,777 |
| Anesthesia for Screening Colonoscopy | $190$72$634 | $211 | $211 |
| Anesthesia for Upper Endoscopy | $190$72$634 | $211 | $211 |
| Basic Metabolic Panel | $283$25$301 | $298 | $298 |
| Bone Marrow Biopsy | $1,149$72$2.1k | $2,071 | $2,071 |
| Breast Biopsy (Ultrasound-guided) | $3,291$72$3.7k | $3,656 | $3,656 |
| Bunion Correction Surgery | $1,947$72$5.8k | $1,947 | $1,947 |
| Cardiac Stress Test (Treadmill) | $1,066$72$1.3k | $1,317 | $1,317 |
| Carpal Tunnel Release Surgery | $5,900$72$6.5k | $6,795 | $6,795 |
| Cataract Surgery with Lens Implant | $5,353$72$9.3k | $6,298 | $6,298 |
| Cesarean Delivery (Global Package) | $11,221$72$40k | $13,201 | $13,201 |
| Chemotherapy Infusion (First Hour) | $748$670$796 | $788 | $788 |
| Chest X-ray (2 Views) | $347$37$381 | $365 | $365 |
| Colonoscopy with Biopsy | $3,086$72$4.0k | $3,944 | $3,944 |
| Complete Abdominal Ultrasound | $1,125$72$1.7k | $1,250 | $1,250 |
| Complete Blood Count (CBC) with Differential | $182$15$193 | $191 | $191 |
| Comprehensive Metabolic Panel | $382$42$406 | $402 | $402 |
| Critical Care, First Hour | $4,874$72$5.5k | $5,416 | $5,416 |
| CT Abdomen and Pelvis with Contrast | $4,480$72$5.0k | $4,978 | $4,978 |
| CT Cardiac Calcium Scoring | $198$177$210 | $208 | $208 |
| CT Chest without Contrast | $681$72$2.4k | $505 | $505 |
| CT Head without Contrast | $2,425$72$2.7k | $2,694 | $2,694 |
| DEXA Bone Density Scan | $533$33$589 | $566 | $566 |
| Diagnostic Colonoscopy | $1,831$72$3.0k | $3,196 | $3,196 |
| Diagnostic Mammogram (Both Breasts) | $860$72$1.9k | $956 | $956 |
| Ear Tube Placement (Tympanostomy) | $2,292$72$7.2k | $7,124 | $7,124 |
| Echocardiogram (Complete with Doppler) | $2,943$72$3.4k | $3,363 | $3,363 |
| EKG (Electrocardiogram, 12-lead) | $391$350$416 | $412 | $412 |
| Emergency Room Visit (Level 3) | $1,032$72$1.9k | $1,146 | $1,146 |
| Group Therapy Session | $72$35$293 | $73 | $73 |
| Hemoglobin A1c (Diabetes Test) | $145$15$154 | $153 | $153 |
| Holter Monitor (24-48 Hour Heart Monitor) | $408$72$1.2k | $408 | $408 |
| Individual Therapy Session (45 Minutes) | $240$72$985 | $278 | $278 |
| Inguinal Hernia Repair (Open) | $2,530$72$7.6k | $2,530 | $2,530 |
| Initial Hospital Admission (Level 1) | $519$72$1.8k | $611 | $611 |
| Initial Psychiatric Diagnostic Evaluation | $209$72$2.2k | $361 | $361 |
| Initial Psychiatric Evaluation with Medication Management | $548$72$2.4k | $716 | $716 |
| IUD Insertion | $573$72$976 | $637 | $637 |
| IUD Removal | $514$72$1.0k | $587 | $587 |
| Knee Arthroscopy with Meniscectomy | $4,884$72$7.9k | $8,280 | $8,280 |
| Laparoscopic Appendectomy | $8,802$72$13k | $12,974 | $12,974 |
| Laparoscopic Gallbladder Removal | $4,210$72$9.7k | $5,955 | $5,955 |
| Laparoscopic Tubal Ligation | $3,235$72$9.7k | $3,235 | $3,235 |
| Lipid Panel (Cholesterol Test) | $248$35$264 | $261 | $261 |
| Lumbar Epidural Steroid Injection | $1,706$72$2.7k | $2,661 | $2,661 |
| Lumbar Puncture (Spinal Tap) | $1,474$72$1.7k | $1,638 | $1,638 |
| Lumpectomy (Partial Mastectomy) | $3,165$72$9.5k | $3,165 | $3,165 |
| MRI Abdomen with and without Contrast | $3,730$72$6.7k | $4,388 | $4,388 |
| MRI Brain with and without Contrast | $4,290$72$5.1k | $4,766 | $4,766 |
| MRI Brain with Contrast | $2,839$72$5.8k | $6,089 | $6,089 |
| MRI Brain without Contrast | $3,888$72$4.4k | $4,320 | $4,320 |
| MRI Cervical Spine (Neck) without Contrast | $3,313$72$3.7k | $3,681 | $3,681 |
| MRI Knee without Contrast | $2,871$72$3.4k | $2,215 | $2,215 |
| MRI Lower Back (Lumbar Spine) without Contrast | $3,011$72$3.6k | $3,610 | $3,610 |
| MRI Thoracic Spine (Mid-back) without Contrast | $3,048$72$3.6k | $3,613 | $3,613 |
| Newborn Circumcision | $5,322$72$6.1k | $6,082 | $6,082 |
| Office Visit, Established Patient (Level 3) | $222$72$788 | $247 | $247 |
| Office Visit, New Patient (Level 3) | $247$72$1.0k | $274 | $274 |
| Pregnancy Ultrasound (Second or Third Trimester) | $790$72$1.9k | $878 | $878 |
| Prostate Biopsy | $505$72$1.5k | $505 | $505 |
| PSA Prostate Cancer Screening | $232$45$247 | $245 | $245 |
| Pulmonary Function Test with Bronchodilator | $1,068$956$1.1k | $1,124 | $1,124 |
| Rotator Cuff Repair (Arthroscopic) | $7,759$72$15k | $8,867 | $8,867 |
| Screening Mammogram | $587$72$1.8k | $653 | $653 |
| Septoplasty (Deviated Septum Repair) | $5,913$72$8.7k | $6,758 | $6,758 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $1,696$72$6.0k | $1,995 | $1,995 |
| Skin Biopsy (Tangential) | $543$72$609 | $603 | $603 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $2,300$72$2.7k | $2,705 | $2,705 |
| Spirometry (Breathing Test) | $471$28$561 | $556 | $556 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $1,472$72$4.4k | $1,472 | $1,472 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $1,413$72$4.2k | $1,413 | $1,413 |
| Total Hip Replacement | $12,970$72$21k | $22,445 | $22,445 |
| Total Knee Replacement | $13,360$72$24k | $25,708 | $25,708 |
| Total Mastectomy | $8,979$72$15k | $10,261 | $10,261 |
| TSH Thyroid Function Test | $301$53$320 | $317 | $317 |
| Upper GI Endoscopy (EGD) | $1,875$72$3.6k | $3,522 | $3,522 |
| Urinalysis with Microscopy | $99$3$105 | $104 | $104 |
| Vaginal Birth After Cesarean (VBAC) Global Package | $9,711$72$32k | $10,646 | $10,646 |
| Vaginal Delivery (Global Package) | $10,117$72$36k | $11,902 | $11,902 |
| Vasectomy | $3,372$72$6.8k | $6,699 | $6,699 |
| Vitamin D Blood Test | $320$100$340 | $337 | $337 |