| Abdominal Hysterectomy | $12,370$196$15k | $3,609 | $3,609 |
| ACL Reconstruction (Arthroscopic) | $6,539$196$7.9k | — | — |
| Allergy Skin Testing | $879$2$1.1k | $925 | $925 |
| Basic Metabolic Panel | $157$8$187 | $197 | $197 |
| Bone Marrow Biopsy | $1,821$196$2.1k | $2,170 | $2,170 |
| Breast Biopsy (Ultrasound-guided) | $3,692$196$4.7k | $4,411 | $4,411 |
| Bunion Correction Surgery | $2,970$196$3.6k | — | — |
| Cardiac Ablation for Atrial Fibrillation | $22,457$687$27k | — | — |
| Cardiac Catheterization (Left Heart) | $6,931$660$8.0k | $8,411 | $8,411 |
| Cardiac Stress Test (Treadmill) | $49 | — | — |
| Carpal Tunnel Release Surgery | $10,213$196$20k | $16,126 | $16,126 |
| Cataract Surgery with Lens Implant | $6,422$196$15k | $11,118 | $11,118 |
| Cervical Spinal Fusion (Anterior) | $12,320$196$14k | $14,080 | $14,080 |
| Cesarean Delivery (Global Package) | $1,990 | $5,054 | $5,054 |
| Chemotherapy Infusion (First Hour) | $725$80$836 | $880 | $880 |
| Chest X-ray (2 Views) | $400$22$428 | $442 | $442 |
| Colonoscopy with Biopsy | $3,187$196$3.7k | $3,868 | $3,868 |
| Complete Abdominal Ultrasound | $1,035$76$1.2k | $1,255 | $1,255 |
| Complete Blood Count (CBC) with Differential | $107$7$129 | $124 | $124 |
| Comprehensive Metabolic Panel | $281$10$314 | $318 | $318 |
| Coronary Angioplasty with Stent | $15,357$429$18k | $18,634 | $18,634 |
| Critical Care, First Hour | $2,151$155$2.5k | $2,610 | $2,610 |
| CT Abdomen and Pelvis with Contrast | $4,915$202$5.7k | $5,964 | $5,964 |
| CT Cardiac Calcium Scoring | $248$66$321 | $301 | $301 |
| CT Chest without Contrast | $1,593$90$1.8k | $1,933 | $1,933 |
| CT Head without Contrast | $1,593$72$1.8k | $1,933 | $1,933 |
| DEXA Bone Density Scan | $584$26$673 | $708 | $708 |
| Diagnostic Colonoscopy | $3,931$100$4.5k | $4,770 | $4,770 |
| Diagnostic Mammogram (Both Breasts) | $565$104$620 | $614 | $614 |
| Ear Tube Placement (Tympanostomy) | $7,341$196$15k | $11,591 | $11,591 |
| Echocardiogram (Complete with Doppler) | $589$128$3.2k | $673 | $673 |
| EKG (Electrocardiogram, 12-lead) | $10 | — | — |
| Emergency Room Visit (Level 3) | $289$52$313 | $330 | $330 |
| Group Therapy Session | $94$18$342 | $99 | $99 |
| Hemodialysis Treatment | $73 | — | — |
| Hemoglobin A1c (Diabetes Test) | $29$9$164 | $37 | $37 |
| HIV Antibody Test | $31$8$37 | $39 | $39 |
| Holter Monitor (24-48 Hour Heart Monitor) | $46 | — | — |
| Home Sleep Study | $715$65$824 | $867 | $867 |
| Individual Therapy Session (45 Minutes) | $240$68$286 | $252 | $252 |
| Inguinal Hernia Repair (Open) | $11,279$196$23k | $17,809 | $17,809 |
| Initial Hospital Admission (Level 1) | $60 | $156 | $156 |
| Initial Psychiatric Diagnostic Evaluation | $269$107$308 | $307 | $307 |
| Initial Psychiatric Evaluation with Medication Management | $178$123$200 | $210 | $210 |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | $3,481$220$4.0k | $4,224 | $4,224 |
| IUD Insertion | $408$45$3.3k | $440 | $440 |
| IUD Removal | $314$100$691 | $529 | $529 |
| Knee Arthroscopy with Meniscectomy | $10,373$196$21k | $16,379 | $16,379 |
| Laparoscopic Appendectomy | $7,157$196$8.2k | $8,684 | $8,684 |
| Laparoscopic Gallbladder Removal | $13,677$196$16k | $16,596 | $16,596 |
| Laparoscopic Tubal Ligation | $14,687$196$29k | $16,614 | $16,614 |
| Lipid Panel (Cholesterol Test) | $124$12$430 | $156 | $156 |
| Lumbar Epidural Steroid Injection | $3,641$71$7.8k | $4,419 | $4,419 |
| Lumbar Puncture (Spinal Tap) | $634$196$1.5k | $1,097 | $1,097 |
| Lumbar Spinal Fusion (Posterior) | $16,834$1.2k$20k | — | — |
| Lumpectomy (Partial Mastectomy) | $9,766$196$21k | $16,026 | $16,026 |
| MRI Abdomen with and without Contrast | $4,968$226$5.7k | $6,028 | $6,028 |
| MRI Brain with and without Contrast | $4,968$215$5.7k | $6,028 | $6,028 |
| MRI Brain with Contrast | $4,298$181$5.0k | $5,216 | $5,216 |
| MRI Brain without Contrast | $1,485$132$3.4k | $1,802 | $1,802 |
| MRI Cervical Spine (Neck) without Contrast | $2,825$129$3.4k | $3,474 | $3,474 |
| MRI Knee without Contrast | $3,154$136$3.4k | $3,605 | $3,605 |
| MRI Lower Back (Lumbar Spine) without Contrast | $1,712$129$3.4k | $2,704 | $2,704 |
| MRI Thoracic Spine (Mid-back) without Contrast | $1,712$129$3.4k | $2,704 | $2,704 |
| Newborn Circumcision | $1,875$196$5.7k | $3,739 | $3,739 |
| Nuclear Cardiac Stress Test | $1,724$274$9.4k | $5,836 | $5,836 |
| Office Visit, Established Patient (Level 3) | $47 | $87 | $87 |
| Office Visit, New Patient (Level 3) | $59 | $128 | $128 |
| Pacemaker Insertion (Dual Chamber) | $25,740$196$30k | $31,233 | $31,233 |
| PET/CT Scan, Whole Body | $18,131$1.0k$19k | $20,034 | $20,034 |
| Pregnancy Ultrasound (Second or Third Trimester) | $739$89$1.6k | $1,224 | $1,224 |
| Prostate Biopsy | $3,822$196$5.6k | $4,638 | $4,638 |
| PSA Prostate Cancer Screening | $198$17$236 | $249 | $249 |
| Pulmonary Function Test with Bronchodilator | $388$26$447 | $471 | $471 |
| Rotator Cuff Repair (Arthroscopic) | $6,539$196$7.9k | — | — |
| Screening Mammogram | $392$85$412 | $433 | $433 |
| Septoplasty (Deviated Septum Repair) | $9,870$196$11k | $11,976 | $11,976 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $6,337$196$7.7k | — | — |
| Skin Biopsy (Tangential) | $214$180$431 | $339 | $339 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $1,483$196$5.6k | $3,698 | $3,698 |
| Sleep Study (In-lab Polysomnography) | $1,965$409$3.9k | $3,102 | $3,102 |
| Spinal Cord Stimulator Trial | $13,366$196$27k | $21,103 | $21,103 |
| Spirometry (Breathing Test) | $294$18$357 | $361 | $361 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $7,645$196$8.8k | $9,276 | $9,276 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $6,756$196$7.8k | $8,171 | $8,171 |
| Total Hip Replacement | $11,778$935$14k | — | — |
| Total Knee Replacement | $11,778$196$14k | — | — |
| Total Mastectomy | $7,124$196$14k | $11,248 | $11,248 |
| TSH Thyroid Function Test | $205$15$245 | $257 | $257 |
| TURP (Transurethral Prostate Resection) | $4,654$196$5.6k | $2,006 | $2,006 |
| Umbilical Hernia Repair | $388$328$579 | — | — |
| Upper GI Endoscopy (EGD) | $3,187$100$3.7k | $3,868 | $3,868 |
| Urinalysis with Microscopy | $3$3$5 | — | — |
| Vaginal Birth After Cesarean (VBAC) Global Package | $1,878 | $5,936 | $5,936 |
| Vaginal Delivery (Global Package) | $1,780 | $5,712 | $5,712 |
| Vaginal Hysterectomy | $4,519$196$5.5k | $2,851 | $2,851 |
| Vasectomy | $4,776$196$11k | $5,796 | $5,796 |
| Vitamin D Blood Test | $283$27$337 | $355 | $355 |