| Abdominal Hysterectomy | $5,390$1.5k$9.7k | $4,350 | — |
| ACL Reconstruction (Arthroscopic) | $7,807$1.8k$24k | $4,350 | — |
| Allergy Skin Testing | $1,112$20$2.2k | — | — |
| Basic Metabolic Panel | $10$4$159 | $9 | $164 |
| Bone Marrow Biopsy | $2,582$388$4.5k | $4,350 | $3,907 |
| Breast Biopsy (Ultrasound-guided) | $3,266$1.8k$5.4k | $4,350 | $4,963 |
| Bunion Correction Surgery | $4,073$1.3k$7.1k | $4,350 | — |
| Cardiac Ablation for Atrial Fibrillation | $34,235$13k$56k | — | — |
| Cardiac Catheterization (Left Heart) | $8,771$3.2k$21k | — | — |
| Cardiac Stress Test (Treadmill) | $465$395$1.4k | — | — |
| Carpal Tunnel Release Surgery | $3,514$713$5.4k | $4,350 | — |
| Cataract Surgery with Lens Implant | $4,288$2.1k$12k | $4,350 | — |
| Cervical Spinal Fusion (Anterior) | $11,729$3.0k$28k | $4,350 | — |
| Cesarean Delivery (Global Package) | $3,903$2.4k$4.5k | $4,350 | — |
| Chemotherapy Infusion (First Hour) | $1,318$125$2.3k | $554 | $2,332 |
| Chest X-ray (2 Views) | $97$31$495 | $121 | $510 |
| Colonoscopy with Biopsy | $2,766$819$5.4k | $4,350 | — |
| Complete Abdominal Ultrasound | $204$108$1.1k | $259 | $1,091 |
| Complete Blood Count (CBC) with Differential | $8$4$142 | $9 | $146 |
| Comprehensive Metabolic Panel | $12$5$319 | $12 | $328 |
| Coronary Angioplasty with Stent | $36,655$12k$51k | — | — |
| Critical Care, First Hour | $1,795$921$5.4k | $1,323 | $5,566 |
| CT Abdomen and Pelvis with Contrast | $593$221$3.5k | $857 | $3,605 |
| CT Cardiac Calcium Scoring | $121$10$1.8k | $13 | $56 |
| CT Chest without Contrast | $260$116$2.1k | $522 | $2,195 |
| CT Head without Contrast | $256$116$2.0k | $496 | $2,085 |
| DEXA Bone Density Scan | $143$79$843 | $206 | $868 |
| Diagnostic Colonoscopy | $2,766$679$5.4k | $4,350 | — |
| Diagnostic Mammogram (Both Breasts) | $190$110$760 | $186 | $783 |
| Ear Tube Placement (Tympanostomy) | $3,222$306$6.3k | $4,350 | — |
| Echocardiogram (Complete with Doppler) | $1,956$414$4.0k | $934 | $3,931 |
| EKG (Electrocardiogram, 12-lead) | $334$284$360 | — | — |
| Emergency Room Visit (Level 3) | $1,342$303$2.8k | $537 | $2,261 |
| Group Therapy Session | $101$31$201 | — | — |
| Hemodialysis Treatment | $1,541$1.3k$1.6k | — | — |
| Hemoglobin A1c (Diabetes Test) | $10$5$112 | $11 | $115 |
| HIV Antibody Test | $10$4$109 | $10 | $112 |
| Holter Monitor (24-48 Hour Heart Monitor) | $449$382$1.0k | — | — |
| Home Sleep Study | $320$171$3.6k | — | — |
| Individual Therapy Session (45 Minutes) | $176$100$349 | — | — |
| Inguinal Hernia Repair (Open) | $4,791$828$7.7k | $4,350 | — |
| Initial Hospital Admission (Level 1) | $7,166$1.3k$11k | — | — |
| Initial Psychiatric Diagnostic Evaluation | $498$162$833 | $204 | $858 |
| Initial Psychiatric Evaluation with Medication Management | $560$176$937 | $229 | $965 |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | $1,572$632$4.9k | — | — |
| IUD Insertion | $2,845$2.1k$4.5k | $4,350 | — |
| IUD Removal | $2,273$332$4.5k | $4,350 | — |
| Knee Arthroscopy with Meniscectomy | $5,115$1.2k$24k | $4,350 | — |
| Laparoscopic Appendectomy | $6,376$931$13k | $4,350 | — |
| Laparoscopic Gallbladder Removal | $7,975$495$13k | $4,350 | — |
| Laparoscopic Tubal Ligation | $7,026$1.2k$13k | $4,350 | — |
| Lipid Panel (Cholesterol Test) | $15$6$240 | $15 | $247 |
| Lumbar Epidural Steroid Injection | $2,461$181$4.5k | $4,350 | $4,047 |
| Lumbar Puncture (Spinal Tap) | $1,649$66$4.5k | $4,350 | $2,405 |
| Lumbar Spinal Fusion (Posterior) | $14,747$2.6k$40k | $4,350 | — |
| Lumpectomy (Partial Mastectomy) | $4,278$3.2k$8.3k | $4,350 | — |
| MRI Abdomen with and without Contrast | $730$326$4.4k | $1,080 | $4,542 |
| MRI Brain with and without Contrast | $730$326$4.9k | $1,198 | $5,038 |
| MRI Brain with Contrast | $636$326$3.5k | $859 | $3,615 |
| MRI Brain without Contrast | $494$264$3.3k | $779 | $3,279 |
| MRI Cervical Spine (Neck) without Contrast | $486$264$3.3k | $655 | $2,756 |
| MRI Knee without Contrast | $377$264$3.3k | — | $2,458 |
| MRI Lower Back (Lumbar Spine) without Contrast | $494$264$3.3k | $678 | $2,854 |
| MRI Thoracic Spine (Mid-back) without Contrast | $494$264$3.3k | $712 | $2,996 |
| Newborn Circumcision | $2,812$245$5.0k | $4,350 | — |
| Nuclear Cardiac Stress Test | $1,427$276$4.8k | $1,166 | $4,904 |
| Office Visit, Established Patient (Level 3) | $308$82$498 | $122 | $513 |
| Office Visit, New Patient (Level 3) | $347$64$561 | $137 | $578 |
| Pacemaker Insertion (Dual Chamber) | $11,437$1.2k$42k | $4,350 | $42,168 |
| PET/CT Scan, Whole Body | $2,280$1.6k$4.2k | — | $9,166 |
| Pregnancy Ultrasound (Second or Third Trimester) | $196$106$904 | $221 | $931 |
| Prostate Biopsy | $3,417$172$5.4k | $4,350 | — |
| PSA Prostate Cancer Screening | $21$9$310 | $20 | $319 |
| Pulmonary Function Test with Bronchodilator | $742$266$1.4k | $343 | $1,441 |
| Rotator Cuff Repair (Arthroscopic) | $7,963$1.8k$24k | $4,350 | — |
| Screening Mammogram | $158$84$616 | $151 | $634 |
| Septoplasty (Deviated Septum Repair) | $4,092$883$7.1k | $4,350 | — |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $7,565$818$15k | $4,350 | — |
| Skin Biopsy (Tangential) | $577$193$4.5k | $4,350 | $1,044 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $1,806$282$5.4k | $4,350 | $3,041 |
| Sleep Study (In-lab Polysomnography) | $1,792$1.1k$4.7k | — | — |
| Spinal Cord Stimulator Trial | $7,172$1.8k$14k | $4,350 | — |
| Spirometry (Breathing Test) | $498$151$790 | $193 | $814 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $4,288$554$8.0k | $4,350 | — |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $6,257$485$13k | $4,350 | — |
| Total Hip Replacement | $21,489$2.7k$28k | $4,350 | — |
| Total Knee Replacement | $21,489$2.7k$28k | $4,350 | — |
| Total Mastectomy | $7,116$3.3k$14k | $4,350 | — |
| TSH Thyroid Function Test | $19$8$267 | $18 | $275 |
| TURP (Transurethral Prostate Resection) | $5,556$3.3k$11k | $4,350 | — |
| Upper GI Endoscopy (EGD) | $2,101$618$4.5k | $4,350 | — |
| Urinalysis with Microscopy | $3$1$109 | $3 | $112 |
| Vaginal Birth After Cesarean (VBAC) Global Package | $4,540$3.3k$4.5k | $4,350 | — |
| Vaginal Delivery (Global Package) | $3,903$2.1k$4.5k | $4,350 | — |
| Vaginal Hysterectomy | $5,503$1.4k$13k | $4,350 | — |
| Vasectomy | $3,566$2.2k$5.4k | $4,350 | — |
| Vitamin D Blood Test | $33$14$273 | $33 | $281 |