| ACL Reconstruction (Arthroscopic) | $7,956$614$17k | $54,655 | $54,655 |
| Allergy Skin Testing | $946$897$2.0k | — | — |
| Basic Metabolic Panel | $9$8$19 | $504 | $504 |
| Bone Marrow Biopsy | $1,820$1.7k$3.8k | $621 | $621 |
| Breast Biopsy (Ultrasound-guided) | $1,820$1.7k$3.8k | $5,341 | $5,341 |
| Bunion Correction Surgery | $3,588$614$7.6k | — | — |
| Cardiac Ablation for Atrial Fibrillation | $28,796$27k$61k | $62,183 | $62,183 |
| Cardiac Catheterization (Left Heart) | $3,572$3.4k$7.5k | $23,279 | $23,279 |
| Carpal Tunnel Release Surgery | $2,141$537$4.5k | $20,663 | $20,663 |
| Cataract Surgery with Lens Implant | $2,531$1.2k$5.4k | $18,704 | $18,704 |
| Cervical Spinal Fusion (Anterior) | $14,145$13k$30k | — | — |
| Chemotherapy Infusion (First Hour) | $364$345$766 | $1,436 | $1,436 |
| Chest X-ray (2 Views) | $100$91$202 | $1,158 | $1,158 |
| Colonoscopy with Biopsy | $1,312$537$2.8k | $12,167 | $12,167 |
| Complete Abdominal Ultrasound | $180$109$321 | $5,248 | $5,248 |
| Complete Blood Count (CBC) with Differential | $8$8$17 | $443 | $443 |
| Comprehensive Metabolic Panel | $11$11$23 | $808 | $808 |
| Coronary Angioplasty with Stent | $12,718$12k$27k | $33,589 | $33,589 |
| Critical Care, First Hour | $910$863$1.9k | $7,182 | $7,182 |
| CT Abdomen and Pelvis with Contrast | $430$364$930 | $9,615 | $9,615 |
| CT Cardiac Calcium Scoring | $96$30$202 | $811 | $811 |
| CT Chest without Contrast | $173$109$302 | $5,984 | $5,984 |
| CT Head without Contrast | $173$109$302 | $5,584 | $5,584 |
| DEXA Bone Density Scan | $124$109$242 | $1,476 | $1,476 |
| Diagnostic Colonoscopy | $1,020$537$2.2k | — | — |
| Diagnostic Mammogram (Both Breasts) | $165$113$275 | $687 | $687 |
| Ear Tube Placement (Tympanostomy) | $1,701$614$3.6k | $15,515 | $15,515 |
| Echocardiogram (Complete with Doppler) | $602$571$1.3k | $3,965 | $3,965 |
| Emergency Room Visit (Level 3) | $301$285$633 | $1,908 | $1,908 |
| Group Therapy Session | — | $927 | $927 |
| Hemodialysis Treatment | — | $1,357 | $1,357 |
| Hemoglobin A1c (Diabetes Test) | $10$10$22 | $264 | $264 |
| HIV Antibody Test | $9$9$20 | $188 | $188 |
| Home Sleep Study | $238$225$501 | $1,708 | $1,708 |
| Individual Therapy Session (45 Minutes) | — | $1,650 | $1,650 |
| Inguinal Hernia Repair (Open) | $3,926$758$8.3k | $32,065 | $32,065 |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | — | $2,809 | $2,809 |
| IUD Removal | $336$318$706 | $3,468 | $3,468 |
| Knee Arthroscopy with Meniscectomy | $3,588$758$7.6k | $31,046 | $31,046 |
| Laparoscopic Appendectomy | $6,660$6.3k$14k | — | — |
| Laparoscopic Gallbladder Removal | $6,660$6.3k$14k | $59,775 | $59,775 |
| Laparoscopic Tubal Ligation | $6,629$863$14k | $54,981 | $54,981 |
| Lipid Panel (Cholesterol Test) | $14$13$30 | $596 | $596 |
| Lumbar Epidural Steroid Injection | $778$737$1.6k | $2,270 | $2,270 |
| Lumbar Puncture (Spinal Tap) | $774$401$1.6k | $2,410 | $2,410 |
| Lumbar Spinal Fusion (Posterior) | $19,317$18k$41k | — | — |
| Lumpectomy (Partial Mastectomy) | $4,314$4.1k$9.1k | — | — |
| MRI Abdomen with and without Contrast | $630$364$1.2k | $7,084 | $7,084 |
| MRI Brain with and without Contrast | $630$364$1.2k | $5,180 | $5,180 |
| MRI Brain with Contrast | $430$364$1.0k | $5,071 | $5,071 |
| MRI Brain without Contrast | $394$249$703 | $4,813 | $4,813 |
| MRI Cervical Spine (Neck) without Contrast | $394$249$703 | $4,368 | $4,368 |
| MRI Knee without Contrast | $394$249$703 | $4,865 | $4,865 |
| MRI Lower Back (Lumbar Spine) without Contrast | $394$249$703 | $4,270 | $4,270 |
| MRI Thoracic Spine (Mid-back) without Contrast | $394$249$703 | $5,093 | $5,093 |
| Newborn Circumcision | $2,292$401$4.8k | — | — |
| Nuclear Cardiac Stress Test | $1,575$1.4k$3.0k | $11,728 | $11,728 |
| Office Visit, Established Patient (Level 3) | — | $549 | $549 |
| Office Visit, New Patient (Level 3) | — | $656 | $656 |
| Pacemaker Insertion (Dual Chamber) | $11,515$11k$24k | $47,123 | $47,123 |
| PET/CT Scan, Whole Body | $1,790$1.5k$3.3k | $24,122 | $24,122 |
| Pregnancy Ultrasound (Second or Third Trimester) | $180$109$321 | $3,208 | $3,208 |
| Prostate Biopsy | $537 | $3,810 | $3,810 |
| PSA Prostate Cancer Screening | $19$18$41 | $301 | $301 |
| Pulmonary Function Test with Bronchodilator | $411$390$865 | $1,636 | $1,636 |
| Rotator Cuff Repair (Arthroscopic) | $7,956$863$17k | $54,655 | $54,655 |
| Screening Mammogram | $137$87$228 | $525 | $525 |
| Septoplasty (Deviated Septum Repair) | $3,635$758$7.7k | $30,746 | $30,746 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $7,738$863$16k | — | — |
| Skin Biopsy (Tangential) | $448$425$942 | $470 | $470 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $1,820$1.7k$3.8k | — | — |
| Sleep Study (In-lab Polysomnography) | $946$897$2.0k | $11,386 | $11,386 |
| Spinal Cord Stimulator Trial | $6,988$537$15k | — | — |
| Spirometry (Breathing Test) | $238$225$501 | $903 | $903 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $3,635$863$7.7k | — | — |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $6,491$614$14k | $61,055 | $61,055 |
| Total Hip Replacement | $14,145$13k$30k | — | — |
| Total Knee Replacement | $14,145$13k$30k | — | — |
| Total Mastectomy | $7,316$6.9k$15k | — | — |
| TSH Thyroid Function Test | $18$17$37 | $403 | $403 |
| TURP (Transurethral Prostate Resection) | $5,879$758$12k | — | — |
| Umbilical Hernia Repair | $758 | — | — |
| Upper GI Endoscopy (EGD) | $995$401$2.1k | $8,175 | $8,175 |
| Urinalysis with Microscopy | $3$3$7 | $325 | $325 |
| Vaginal Hysterectomy | $5,511$5.2k$12k | — | — |
| Vasectomy | $2,292$537$4.8k | — | — |
| Vitamin D Blood Test | $31$30$66 | $118 | $118 |