| Abdominal Hysterectomy | $2,428 | $1,477 | $1,477 |
| ACL Reconstruction (Arthroscopic) | $4,241 | $1,332 | $1,332 |
| Allergy Skin Testing | $1,025$10$1.8k | $15 | $15 |
| Basic Metabolic Panel | $15$6$77 | $74 | $74 |
| Bone Marrow Biopsy | $2,011$648$3.5k | — | — |
| Breast Biopsy (Ultrasound-guided) | $1,120 | $2,000 | $2,000 |
| Bunion Correction Surgery | $4,100$2.4k$7.0k | — | — |
| Cardiac Ablation for Atrial Fibrillation | $31,818$7.8k$56k | — | — |
| Cardiac Catheterization (Left Heart) | $3,947$1.7k$7.0k | — | — |
| Cardiac Stress Test (Treadmill) | $211$24$299 | $302 | $302 |
| Carpal Tunnel Release Surgery | $1,862 | $1,012 | $1,012 |
| Cataract Surgery with Lens Implant | $2,809$1.2k$5.0k | — | — |
| Cervical Spinal Fusion (Anterior) | $15,629$4.2k$28k | — | — |
| Cesarean Delivery (Global Package) | $4,275$456$5.6k | $5,700 | $5,700 |
| Chemotherapy Infusion (First Hour) | $414$214$710 | $597 | $597 |
| Chest X-ray (2 Views) | $109$28$380 | $400 | $400 |
| Colonoscopy with Biopsy | $1,120 | $837 | $837 |
| Complete Abdominal Ultrasound | $132$117$551 | $580 | $580 |
| Complete Blood Count (CBC) with Differential | $13$4$77 | $68 | $68 |
| Comprehensive Metabolic Panel | $12$6$110 | $116 | $116 |
| Coronary Angioplasty with Stent | $14,053$4.2k$25k | — | — |
| Critical Care, First Hour | $996$306$1.8k | $475 | $475 |
| CT Abdomen and Pelvis with Contrast | $1,000 | $4,000 | $4,000 |
| CT Cardiac Calcium Scoring | $109$82$1.0k | — | — |
| CT Chest without Contrast | $1,000 | $1,500 | $1,500 |
| CT Head without Contrast | $1,000 | $1,500 | $1,500 |
| DEXA Bone Density Scan | $131$45$523 | $550 | $550 |
| Diagnostic Colonoscopy | $1,120 | $757 | $757 |
| Diagnostic Mammogram (Both Breasts) | $280$32$396 | $400 | $400 |
| Ear Tube Placement (Tympanostomy) | $1,889$648$3.3k | — | — |
| Echocardiogram (Complete with Doppler) | $691$327$1.9k | $2,000 | $2,000 |
| EKG (Electrocardiogram, 12-lead) | $80$8$105 | $106 | $106 |
| Emergency Room Visit (Level 3) | $150$66$950 | $141 | $141 |
| Group Therapy Session | $121$25$218 | $58 | $58 |
| Hemodialysis Treatment | $573$539$611 | — | — |
| Hemoglobin A1c (Diabetes Test) | $17$3$91 | $96 | $96 |
| HIV Antibody Test | $10$7$17 | — | — |
| Holter Monitor (24-48 Hour Heart Monitor) | $51$48$55 | — | — |
| Home Sleep Study | $258$100$464 | $188 | $188 |
| Individual Therapy Session (45 Minutes) | $148$34$381 | $179 | $179 |
| Inguinal Hernia Repair (Open) | $2,428 | $1,290 | $1,290 |
| Initial Hospital Admission (Level 1) | $194$20$248 | $250 | $250 |
| Initial Psychiatric Diagnostic Evaluation | $213$34$381 | $275 | $275 |
| Initial Psychiatric Evaluation with Medication Management | $222$166$381 | $305 | $305 |
| IUD Insertion | $648 | $280 | $280 |
| IUD Removal | $648 | $219 | $219 |
| Knee Arthroscopy with Meniscectomy | $2,428 | $749 | $749 |
| Laparoscopic Appendectomy | $4,241 | $1,389 | $1,389 |
| Laparoscopic Gallbladder Removal | $4,241 | $1,967 | $1,967 |
| Laparoscopic Tubal Ligation | $4,241 | $953 | $953 |
| Lipid Panel (Cholesterol Test) | $23$6$105 | $85 | $85 |
| Lumbar Epidural Steroid Injection | $648 | $705 | $705 |
| Lumbar Puncture (Spinal Tap) | $648 | $1,130 | $1,130 |
| Lumbar Spinal Fusion (Posterior) | $21,344$4.2k$38k | — | — |
| Lumpectomy (Partial Mastectomy) | $1,862 | $1,098 | $1,098 |
| MRI Abdomen with and without Contrast | $1,650 | $2,580 | $2,580 |
| MRI Brain with and without Contrast | $1,650 | $3,995 | $3,995 |
| MRI Brain with Contrast | $1,650 | $2,850 | $2,850 |
| MRI Brain without Contrast | $1,650 | $2,537 | $2,537 |
| MRI Cervical Spine (Neck) without Contrast | $1,650 | $2,500 | $2,500 |
| MRI Knee without Contrast | $1,650 | $2,316 | $2,316 |
| MRI Lower Back (Lumbar Spine) without Contrast | $1,650 | $2,500 | $2,500 |
| MRI Thoracic Spine (Mid-back) without Contrast | $1,650 | $1,887 | $1,887 |
| Newborn Circumcision | $1,862 | $208 | $208 |
| Nuclear Cardiac Stress Test | $1,802$680$2.8k | $2,643 | $2,643 |
| Office Visit, Established Patient (Level 3) | $135$12$248 | $200 | $200 |
| Office Visit, New Patient (Level 3) | $196$18$248 | $250 | $250 |
| Pacemaker Insertion (Dual Chamber) | $12,724$5.9k$22k | — | — |
| PET/CT Scan, Whole Body | $1,792$923$3.1k | — | — |
| Pregnancy Ultrasound (Second or Third Trimester) | $131$72$379 | $399 | $399 |
| Prostate Biopsy | $1,120 | $286 | $286 |
| PSA Prostate Cancer Screening | $21$9$127 | $130 | $130 |
| Pulmonary Function Test with Bronchodilator | $445$72$802 | $85 | $85 |
| Rotator Cuff Repair (Arthroscopic) | $4,241 | $1,460 | $1,460 |
| Screening Mammogram | $319$30$396 | $388 | $388 |
| Septoplasty (Deviated Septum Repair) | $4,036$1.9k$7.1k | — | — |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $8,591$1.4k$15k | — | — |
| Skin Biopsy (Tangential) | $648 | $212 | $212 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $648 | $157 | $157 |
| Sleep Study (In-lab Polysomnography) | $1,076$537$1.8k | — | — |
| Spinal Cord Stimulator Trial | $7,758$4.2k$14k | — | — |
| Spirometry (Breathing Test) | $247$37$464 | $169 | $169 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $1,862 | $700 | $700 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $1,862 | $589 | $589 |
| Total Hip Replacement | $15,629$6.3k$28k | $765 | $765 |
| Total Knee Replacement | $6,318 | $2,007 | $2,007 |
| Total Mastectomy | $2,428 | $1,875 | $1,875 |
| TSH Thyroid Function Test | $19$9$109 | $115 | $115 |
| TURP (Transurethral Prostate Resection) | $3,478 | $1,370 | $1,370 |
| Upper GI Endoscopy (EGD) | $1,120 | $610 | $610 |
| Urinalysis with Microscopy | $4$2$56 | $59 | $59 |
| Vaginal Birth After Cesarean (VBAC) Global Package | $2,726$291$3.6k | $3,635 | $3,635 |
| Vaginal Delivery (Global Package) | $3,750$400$5.0k | $5,000 | $5,000 |
| Vaginal Hysterectomy | $2,428 | $1,875 | $1,875 |
| Vasectomy | $1,862 | $588 | $588 |
| Vitamin D Blood Test | $37$9$152 | $105 | $105 |