| ACL Reconstruction (Arthroscopic) | $9,070$8.6k$27k | $18,200 | $32,500 |
| Allergy Skin Testing | — | $627 | $1,120 |
| Basic Metabolic Panel | $8$8$25 | $193 | $345 |
| Bone Marrow Biopsy | $2,057$2.0k$6.1k | $2,022 | $3,610 |
| Breast Biopsy (Ultrasound-guided) | $2,057$2.0k$6.1k | $4,094 | $7,310 |
| Bunion Correction Surgery | $4,120$3.9k$12k | $11,094 | $19,810 |
| Cardiac Ablation for Atrial Fibrillation | — | $39,105 | $69,830 |
| Cardiac Catheterization (Left Heart) | $4,084$3.9k$12k | $19,488 | $34,800 |
| Carpal Tunnel Release Surgery | $2,479$2.4k$7.4k | $5,309 | $9,480 |
| Cataract Surgery with Lens Implant | $2,896$2.8k$8.6k | $8,624 | $15,400 |
| Cervical Spinal Fusion (Anterior) | $16,336$16k$49k | $9,951 | $17,770 |
| Chemotherapy Infusion (First Hour) | — | $1,103 | $1,970 |
| Chest X-ray (2 Views) | $124$118$370 | $504 | $900 |
| Colonoscopy with Biopsy | $1,497$1.4k$4.5k | $3,550 | $6,340 |
| Complete Abdominal Ultrasound | $149$142$445 | $991 | $1,770 |
| Complete Blood Count (CBC) with Differential | $8$8$25 | $123 | $220 |
| Comprehensive Metabolic Panel | $10$10$30 | $255 | $456 |
| Coronary Angioplasty with Stent | — | $13,748 | $24,550 |
| Critical Care, First Hour | $6,260 | $5,910 | $10,553 |
| CT Abdomen and Pelvis with Contrast | $500$476$1.5k | $4,754 | $8,490 |
| CT Cardiac Calcium Scoring | $168$160$500 | $314 | $560 |
| CT Chest without Contrast | $190$180$565 | $2,845 | $5,080 |
| CT Head without Contrast | $153$145$455 | $2,682 | $4,790 |
| DEXA Bone Density Scan | $149$142$445 | $504 | $900 |
| Diagnostic Colonoscopy | $1,158$1.1k$3.5k | $3,679 | $6,570 |
| Diagnostic Mammogram (Both Breasts) | $168$160$500 | $504 | $900 |
| Ear Tube Placement (Tympanostomy) | $1,881$1.8k$5.6k | $6,356 | $11,350 |
| Echocardiogram (Complete with Doppler) | — | $3,825 | $6,830 |
| EKG (Electrocardiogram, 12-lead) | — | $90 | $160 |
| Emergency Room Visit (Level 3) | $2,055 | $1,622 | $2,896 |
| Group Therapy Session | — | $532 | $950 |
| Hemodialysis Treatment | — | $1,210 | $2,160 |
| Hemoglobin A1c (Diabetes Test) | $10$10$30 | $80 | $142 |
| HIV Antibody Test | $8$8$25 | $35 | $63 |
| Home Sleep Study | — | $823 | $1,470 |
| Individual Therapy Session (45 Minutes) | — | $582 | $1,040 |
| Inguinal Hernia Repair (Open) | $4,481$4.3k$13k | $18,726 | $33,440 |
| Initial Psychiatric Diagnostic Evaluation | — | $659 | $1,177 |
| Initial Psychiatric Evaluation with Medication Management | — | $2,178 | $3,890 |
| IUD Insertion | — | $1,814 | $3,240 |
| IUD Removal | $386$368$1.2k | $1,562 | $2,790 |
| Knee Arthroscopy with Meniscectomy | $4,120$3.9k$12k | $7,325 | $13,080 |
| Laparoscopic Appendectomy | $7,407$7.0k$22k | $22,680 | $40,500 |
| Laparoscopic Gallbladder Removal | $7,407$7.0k$22k | $19,219 | $34,320 |
| Laparoscopic Tubal Ligation | $7,407$7.0k$22k | $27,653 | $49,380 |
| Lipid Panel (Cholesterol Test) | $13$13$40 | $156 | $279 |
| Lumbar Epidural Steroid Injection | $879$837$2.6k | $3,662 | $6,540 |
| Lumbar Puncture (Spinal Tap) | $879$837$2.6k | $2,066 | $3,690 |
| Lumbar Spinal Fusion (Posterior) | $23,348$22k$70k | $17,646 | $31,510 |
| Lumpectomy (Partial Mastectomy) | $4,862$4.6k$14k | $10,377 | $18,530 |
| MRI Abdomen with and without Contrast | $539$513$1.6k | $5,970 | $10,660 |
| MRI Brain with and without Contrast | $500$476$1.5k | $5,499 | $9,820 |
| MRI Brain with Contrast | $500$476$1.5k | $5,057 | $9,030 |
| MRI Brain without Contrast | $339$323$1.0k | $3,629 | $6,480 |
| MRI Cervical Spine (Neck) without Contrast | $339$323$1.0k | $3,735 | $6,670 |
| MRI Knee without Contrast | $339$323$1.0k | $3,438 | $6,140 |
| MRI Lower Back (Lumbar Spine) without Contrast | $339$323$1.0k | $3,282 | $5,860 |
| MRI Thoracic Spine (Mid-back) without Contrast | $339$323$1.0k | $3,646 | $6,510 |
| Newborn Circumcision | $2,601$2.5k$7.8k | $5,942 | $10,610 |
| Nuclear Cardiac Stress Test | $1,830$1.7k$5.5k | $5,146 | $9,190 |
| Pacemaker Insertion (Dual Chamber) | $13,287$13k$40k | $22,529 | $40,230 |
| PET/CT Scan, Whole Body | $2,045$1.9k$6.1k | $7,218 | $12,890 |
| Pregnancy Ultrasound (Second or Third Trimester) | $149$142$445 | $946 | $1,690 |
| PSA Prostate Cancer Screening | $18$18$55 | $130 | $233 |
| Pulmonary Function Test with Bronchodilator | — | $1,114 | $1,990 |
| Rotator Cuff Repair (Arthroscopic) | $9,070$8.6k$27k | $6,300 | $11,250 |
| Screening Mammogram | $139$133$415 | $375 | $670 |
| Septoplasty (Deviated Septum Repair) | $4,118$3.9k$12k | $9,990 | $17,840 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $8,789$8.4k$26k | $10,881 | $19,430 |
| Skin Biopsy (Tangential) | $252$240$752 | $577 | $1,030 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $2,057$2.0k$6.1k | $3,797 | $6,780 |
| Sleep Study (In-lab Polysomnography) | — | $4,889 | $8,730 |
| Spinal Cord Stimulator Trial | $8,332$7.9k$25k | $8,254 | $14,740 |
| Spirometry (Breathing Test) | — | $487 | $870 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $4,118$3.9k$12k | $10,080 | $18,000 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $7,511$7.1k$22k | $10,634 | $18,990 |
| Total Hip Replacement | $16,336$16k$49k | $9,162 | $16,360 |
| Total Knee Replacement | $16,336$16k$49k | $25,760 | $46,000 |
| Total Mastectomy | $8,280$7.9k$25k | $8,854 | $15,810 |
| TSH Thyroid Function Test | $17$16$50 | $155 | $277 |
| TURP (Transurethral Prostate Resection) | $6,454$6.1k$19k | $16,822 | $30,040 |
| Upper GI Endoscopy (EGD) | $1,190$1.1k$3.5k | $3,707 | $6,620 |
| Urinalysis with Microscopy | $3$3$10 | $83 | $148 |
| Vaginal Hysterectomy | $6,267$6.0k$19k | $14,952 | $26,700 |
| Vasectomy | $2,601$2.5k$7.8k | $8,378 | $14,960 |
| Vitamin D Blood Test | $29$27$85 | $115 | $205 |