| Abdominal Hysterectomy | $5,085$705$6.0k | $4,627 | — |
| ACL Reconstruction (Arthroscopic) | $7,807$845$26k | $4,627 | — |
| Allergy Skin Testing | $1,112$10$3.4k | — | — |
| Basic Metabolic Panel | $9$4$110 | $9 | $164 |
| Bone Marrow Biopsy | $1,771$183$5.4k | $4,627 | $2,934 |
| Breast Biopsy (Ultrasound-guided) | $2,700$1.8k$5.4k | $4,627 | $6,874 |
| Bunion Correction Surgery | $3,546$595$11k | $4,627 | — |
| Cardiac Ablation for Atrial Fibrillation | $32,370$16k$82k | — | — |
| Cardiac Catheterization (Left Heart) | $6,988$2.4k$20k | $2,763 | $21,415 |
| Cardiac Stress Test (Treadmill) | $465$345$662 | — | — |
| Carpal Tunnel Release Surgery | $2,265$336$6.5k | $4,627 | — |
| Cataract Surgery with Lens Implant | $4,045$990$7.6k | $4,627 | — |
| Cervical Spinal Fusion (Anterior) | $14,062$1.4k$43k | $4,627 | — |
| Cesarean Delivery (Global Package) | $1,154 | $4,627 | — |
| Chemotherapy Infusion (First Hour) | $1,152$125$2.1k | $326 | $2,525 |
| Chest X-ray (2 Views) | $97$31$331 | $64 | $493 |
| Colonoscopy with Biopsy | $2,255$386$4.3k | $4,627 | — |
| Complete Abdominal Ultrasound | $169$108$733 | $141 | $1,091 |
| Complete Blood Count (CBC) with Differential | $8$4$98 | $9 | $146 |
| Comprehensive Metabolic Panel | $11$5$220 | $12 | $328 |
| Coronary Angioplasty with Stent | $33,988$11k$51k | — | $21,044 |
| Critical Care, First Hour | $1,613$530$3.9k | $711 | $5,512 |
| CT Abdomen and Pelvis with Contrast | $469$221$3.1k | $465 | $3,605 |
| CT Cardiac Calcium Scoring | $114$6$3.1k | $7 | $56 |
| CT Chest without Contrast | $289$116$3.1k | $433 | $3,358 |
| CT Head without Contrast | $234$116$3.1k | $269 | $2,085 |
| DEXA Bone Density Scan | $128$95$734 | $141 | $1,092 |
| Diagnostic Colonoscopy | $1,783$321$4.3k | $4,627 | — |
| Diagnostic Mammogram (Both Breasts) | $152$87$583 | $101 | $783 |
| Ear Tube Placement (Tympanostomy) | $2,630$144$5.0k | $4,627 | — |
| Echocardiogram (Complete with Doppler) | $1,096$310$3.1k | $568 | $4,406 |
| EKG (Electrocardiogram, 12-lead) | $284$170$334 | — | — |
| Emergency Room Visit (Level 3) | $926$269$2.7k | $313 | $2,428 |
| Group Therapy Session | $101$31$309 | — | — |
| Hemodialysis Treatment | $1,310$751$1.5k | — | — |
| Hemoglobin A1c (Diabetes Test) | $10$5$163 | $11 | $242 |
| HIV Antibody Test | $9$4$91 | $10 | $136 |
| Holter Monitor (24-48 Hour Heart Monitor) | $449$382$473 | — | — |
| Home Sleep Study | $986$171$4.3k | $293 | $2,269 |
| Individual Therapy Session (45 Minutes) | $176$100$537 | — | — |
| Inguinal Hernia Repair (Open) | $3,857$391$12k | $4,627 | — |
| Initial Hospital Admission (Level 1) | $7,511$1.3k$8.8k | — | — |
| Initial Psychiatric Diagnostic Evaluation | $439$104$614 | $118 | $914 |
| Initial Psychiatric Evaluation with Medication Management | $450$104$615 | $118 | $915 |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | $1,627$632$3.0k | — | — |
| IUD Insertion | $569$63$3.1k | $4,627 | $569 |
| IUD Removal | $367$44$3.1k | $4,627 | $395 |
| Knee Arthroscopy with Meniscectomy | $5,085$548$26k | $4,627 | — |
| Laparoscopic Appendectomy | $6,376$439$20k | $4,627 | — |
| Laparoscopic Gallbladder Removal | $6,504$495$20k | $4,627 | — |
| Laparoscopic Tubal Ligation | $6,376$553$20k | $4,627 | — |
| Lipid Panel (Cholesterol Test) | $14$6$166 | $15 | $247 |
| Lumbar Epidural Steroid Injection | $1,830$181$4.0k | $4,627 | $4,047 |
| Lumbar Puncture (Spinal Tap) | $757$66$3.1k | $4,627 | $898 |
| Lumbar Spinal Fusion (Posterior) | $20,098$1.2k$62k | $4,627 | — |
| Lumpectomy (Partial Mastectomy) | $4,185$2.1k$13k | $4,627 | — |
| MRI Abdomen with and without Contrast | $603$326$3.6k | $569 | $4,413 |
| MRI Brain with and without Contrast | $607$326$3.6k | $650 | $5,038 |
| MRI Brain with Contrast | $590$326$3.6k | $466 | $3,615 |
| MRI Brain without Contrast | $425$264$3.6k | $423 | $3,279 |
| MRI Cervical Spine (Neck) without Contrast | $425$264$3.6k | $356 | $2,756 |
| MRI Knee without Contrast | $425$264$3.6k | — | $2,458 |
| MRI Lower Back (Lumbar Spine) without Contrast | $425$264$3.6k | $368 | $2,854 |
| MRI Thoracic Spine (Mid-back) without Contrast | $425$264$3.6k | $386 | $2,996 |
| Newborn Circumcision | $2,239$116$6.9k | $4,627 | — |
| Nuclear Cardiac Stress Test | $1,441$276$6.1k | $1,177 | $9,127 |
| Office Visit, Established Patient (Level 3) | $243$57$345 | $66 | $513 |
| Office Visit, New Patient (Level 3) | $274$64$388 | $75 | $578 |
| Pacemaker Insertion (Dual Chamber) | $11,666$564$41k | $4,627 | $35,205 |
| PET/CT Scan, Whole Body | $1,996$1.6k$4.9k | — | $14,233 |
| Pregnancy Ultrasound (Second or Third Trimester) | $169$103$626 | $120 | $931 |
| Prostate Biopsy | $3,183$81$6.9k | $4,627 | $6,593 |
| PSA Prostate Cancer Screening | $19$9$214 | $20 | $319 |
| Pulmonary Function Test with Bronchodilator | $610$181$1.1k | $210 | $1,631 |
| Rotator Cuff Repair (Arthroscopic) | $7,807$859$26k | $4,627 | — |
| Screening Mammogram | $126$70$481 | $82 | $634 |
| Septoplasty (Deviated Septum Repair) | $3,544$417$11k | $4,627 | — |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $7,565$386$23k | $4,627 | — |
| Skin Biopsy (Tangential) | $380$76$3.1k | $4,627 | $683 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $1,771$133$5.4k | $4,627 | $2,100 |
| Sleep Study (In-lab Polysomnography) | $3,598$862$5.2k | $1,004 | $7,783 |
| Spinal Cord Stimulator Trial | $7,172$826$22k | $4,627 | — |
| Spirometry (Breathing Test) | $408$92$596 | $107 | $828 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $3,615$262$11k | $4,627 | — |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $6,465$229$20k | $4,627 | — |
| Total Hip Replacement | $22,525$10.0k$43k | $4,627 | — |
| Total Knee Replacement | $22,525$10.0k$43k | $4,627 | — |
| Total Mastectomy | $7,127$2.5k$22k | $4,627 | — |
| TSH Thyroid Function Test | $17$8$185 | $18 | $275 |
| TURP (Transurethral Prostate Resection) | $5,556$2.5k$17k | $4,627 | — |
| Upper GI Endoscopy (EGD) | $1,782$291$4.3k | $4,627 | — |
| Urinalysis with Microscopy | $3$1$75 | $3 | $112 |
| Vaginal Birth After Cesarean (VBAC) Global Package | — | $4,627 | — |
| Vaginal Delivery (Global Package) | $984 | $4,627 | — |
| Vaginal Hysterectomy | $5,395$673$17k | $4,627 | — |
| Vasectomy | $2,335$1.8k$6.9k | $4,627 | — |
| Vitamin D Blood Test | $30$14$276 | $33 | $411 |