| Abdominal Hysterectomy | $2,466$82$4.5k | $5,304 | $5,304 |
| ACL Reconstruction (Arthroscopic) | $2,450$82$7.8k | $5,105 | $5,105 |
| Allergy Skin Testing | $17$3$2.6k | $1,537 | $1,537 |
| Basic Metabolic Panel | $51$7$90 | $107 | $107 |
| Bone Marrow Biopsy | $622$62$4.1k | $2,822 | $2,822 |
| Breast Biopsy (Ultrasound-guided) | $1,952$82$4.3k | $4,018 | $4,018 |
| Bunion Correction Surgery | $2,186$82$3.8k | $4,554 | $4,554 |
| Cardiac Ablation for Atrial Fibrillation | $4,768$1.0k$28k | $19,215 | $19,215 |
| Cardiac Catheterization (Left Heart) | $3,488$560$12k | $9,922 | $9,922 |
| Cardiac Stress Test (Treadmill) | $74$70$133 | — | — |
| Carpal Tunnel Release Surgery | $1,069$82$2.1k | $2,227 | $2,227 |
| Cataract Surgery with Lens Implant | $1,312$82$2.5k | $2,734 | $2,734 |
| Cervical Spinal Fusion (Anterior) | $4,340$82$14k | $9,041 | $9,041 |
| Cesarean Delivery (Global Package) | $5,793$82$10k | $12,458 | $12,458 |
| Chemotherapy Infusion (First Hour) | $567$130$992 | $1,181 | $1,181 |
| Chest X-ray (2 Views) | $158$19$286 | $340 | $340 |
| Colonoscopy with Biopsy | $1,399$82$2.7k | $2,645 | $2,645 |
| Complete Abdominal Ultrasound | $464$72$811 | $966 | $966 |
| Complete Blood Count (CBC) with Differential | $38$7$70 | $75 | $75 |
| Comprehensive Metabolic Panel | $83$9$270 | $144 | $144 |
| Coronary Angioplasty with Stent | $2,516$82$12k | $8,320 | $8,320 |
| Critical Care, First Hour | $564$82$1.7k | $1,411 | $1,411 |
| CT Abdomen and Pelvis with Contrast | $2,935$162$5.5k | $6,523 | $6,523 |
| CT Cardiac Calcium Scoring | $309$52$1.7k | $644 | $644 |
| CT Chest without Contrast | $1,530$95$2.9k | $3,399 | $3,399 |
| CT Head without Contrast | $1,486$75$2.8k | $3,303 | $3,303 |
| DEXA Bone Density Scan | $361$18$652 | $776 | $776 |
| Diagnostic Colonoscopy | $1,084$82$2.0k | $2,032 | $2,032 |
| Diagnostic Mammogram (Both Breasts) | $223$88$391 | $465 | $465 |
| Ear Tube Placement (Tympanostomy) | $386$82$1.7k | $805 | $805 |
| Echocardiogram (Complete with Doppler) | $675$82$1.4k | $1,360 | $1,360 |
| EKG (Electrocardiogram, 12-lead) | $15$15$27 | — | — |
| Emergency Room Visit (Level 3) | $401$52$701 | $835 | $835 |
| Group Therapy Session | $54$16$210 | $165 | $165 |
| Hemodialysis Treatment | $101$90$192 | — | — |
| Hemoglobin A1c (Diabetes Test) | $38$5$151 | $80 | $80 |
| HIV Antibody Test | $47$8$110 | $76 | $76 |
| Holter Monitor (24-48 Hour Heart Monitor) | $75$66$127 | — | — |
| Home Sleep Study | $3,429$81$6.0k | $7,143 | $7,143 |
| Individual Therapy Session (45 Minutes) | $164$53$245 | $279 | $279 |
| Inguinal Hernia Repair (Open) | $1,329$82$3.8k | $2,768 | $2,768 |
| Initial Hospital Admission (Level 1) | $75$20$245 | $195 | $195 |
| Initial Psychiatric Diagnostic Evaluation | $247$82$346 | $410 | $410 |
| Initial Psychiatric Evaluation with Medication Management | $278$91$391 | $459 | $459 |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | $306$297$376 | — | — |
| IUD Insertion | $292$44$511 | $567 | $567 |
| IUD Removal | $249$58$436 | $501 | $501 |
| Knee Arthroscopy with Meniscectomy | $1,339$82$3.5k | $2,790 | $2,790 |
| Laparoscopic Appendectomy | $1,535$82$6.5k | $3,197 | $3,197 |
| Laparoscopic Gallbladder Removal | $1,683$82$6.5k | $3,506 | $3,506 |
| Laparoscopic Tubal Ligation | $1,646$82$6.5k | $3,429 | $3,429 |
| Lipid Panel (Cholesterol Test) | $69$12$121 | $144 | $144 |
| Lumbar Epidural Steroid Injection | $850$82$1.6k | $1,592 | $1,592 |
| Lumbar Puncture (Spinal Tap) | $501$55$1.1k | $1,003 | $1,003 |
| Lumbar Spinal Fusion (Posterior) | $4,022$82$19k | $8,379 | $8,379 |
| Lumpectomy (Partial Mastectomy) | $1,667$82$4.2k | $3,473 | $3,473 |
| MRI Abdomen with and without Contrast | $3,091$196$5.8k | $6,869 | $6,869 |
| MRI Brain with and without Contrast | $3,091$204$5.8k | $6,869 | $6,869 |
| MRI Brain with Contrast | $3,557$157$6.6k | $7,905 | $7,905 |
| MRI Brain without Contrast | $1,889$131$3.5k | $4,197 | $4,197 |
| MRI Cervical Spine (Neck) without Contrast | $2,104$131$3.9k | $4,675 | $4,675 |
| MRI Knee without Contrast | $2,174$120$4.1k | $4,830 | $4,830 |
| MRI Lower Back (Lumbar Spine) without Contrast | $2,061$131$3.8k | $4,579 | $4,579 |
| MRI Thoracic Spine (Mid-back) without Contrast | $1,980$131$3.7k | $4,401 | $4,401 |
| Newborn Circumcision | $596$82$2.7k | $2,031 | $2,031 |
| Nuclear Cardiac Stress Test | $2,038$139$3.6k | $4,245 | $4,245 |
| Office Visit, Established Patient (Level 3) | $135$42$251 | $255 | $255 |
| Office Visit, New Patient (Level 3) | $182$59$340 | $354 | $354 |
| Pacemaker Insertion (Dual Chamber) | $2,201$82$16k | $11,013 | $11,013 |
| PET/CT Scan, Whole Body | $3,903$212$6.8k | $8,132 | $8,132 |
| Pregnancy Ultrasound (Second or Third Trimester) | $521$88$911 | $1,085 | $1,085 |
| Prostate Biopsy | $1,614$129$2.8k | $3,363 | $3,363 |
| PSA Prostate Cancer Screening | $59$4$186 | $111 | $111 |
| Pulmonary Function Test with Bronchodilator | $322$19$501 | $596 | $596 |
| Rotator Cuff Repair (Arthroscopic) | $2,673$82$7.8k | $5,568 | $5,568 |
| Screening Mammogram | $254$68$445 | $530 | $530 |
| Septoplasty (Deviated Septum Repair) | $1,561$82$3.6k | $3,253 | $3,253 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $810$82$7.6k | $1,687 | $1,687 |
| Skin Biopsy (Tangential) | $317$32$591 | $601 | $601 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $465$68$2.0k | $1,482 | $1,482 |
| Sleep Study (In-lab Polysomnography) | $1,952$82$6.0k | $5,038 | $5,038 |
| Spinal Cord Stimulator Trial | $5,865$82$11k | $11,125 | $11,125 |
| Spirometry (Breathing Test) | $112$15$231 | $208 | $208 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $741$82$3.6k | $1,544 | $1,544 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $715$82$6.3k | $1,489 | $1,489 |
| Total Hip Replacement | $3,403$82$14k | $7,090 | $7,090 |
| Total Knee Replacement | $3,397$82$14k | $7,078 | $7,078 |
| Total Mastectomy | $2,435$82$7.1k | $5,072 | $5,072 |
| TSH Thyroid Function Test | $63$13$125 | $131 | $131 |
| TURP (Transurethral Prostate Resection) | $1,826$82$5.7k | $3,804 | $3,804 |
| Umbilical Hernia Repair | $1,268$82$2.0k | $2,349 | $2,349 |
| Upper GI Endoscopy (EGD) | $709$82$1.2k | $1,434 | $1,434 |
| Urinalysis with Microscopy | $53$3$93 | $111 | $111 |
| Vaginal Birth After Cesarean (VBAC) Global Package | $5,496$82$9.9k | $11,819 | $11,819 |
| Vaginal Delivery (Global Package) | $5,208$82$9.4k | $11,201 | $11,201 |
| Vaginal Hysterectomy | $1,185$731$5.4k | — | — |
| Vasectomy | $1,211$82$2.7k | $2,538 | $2,538 |
| Vitamin D Blood Test | $123$25$230 | $256 | $256 |