| Abdominal Hysterectomy | $8,059$4.5k$12k | $3,342 | $5,570 |
| ACL Reconstruction (Arthroscopic) | $8,059$5.7k$12k | $20,528 | $34,214 |
| Allergy Skin Testing | $953 | — | — |
| Basic Metabolic Panel | $69$49$103 | $335 | $558 |
| Bone Marrow Biopsy | $2,252$1.5k$3.4k | $909 | $1,515 |
| Breast Biopsy (Ultrasound-guided) | $2,252$1.5k$3.4k | $2,981 | $4,969 |
| Bunion Correction Surgery | $4,376$2.9k$6.4k | $9,686 | $16,143 |
| Cardiac Ablation for Atrial Fibrillation | $18,958$18k$22k | — | — |
| Cardiac Catheterization (Left Heart) | $5,512$3.0k$8.0k | $11,152 | $18,586 |
| Carpal Tunnel Release Surgery | $4,265$1.8k$6.4k | $5,897 | $9,829 |
| Cataract Surgery with Lens Implant | $4,617$2.1k$6.9k | — | — |
| Cervical Spinal Fusion (Anterior) | $8,176$5.8k$12k | $10,648 | $17,746 |
| Cesarean Delivery (Global Package) | $4,758$3.4k$7.1k | — | — |
| Chemotherapy Infusion (First Hour) | $309 | — | — |
| Chest X-ray (2 Views) | $182$83$272 | $171 | $285 |
| Colonoscopy with Biopsy | $2,370$1.1k$3.5k | $3,429 | $5,715 |
| Complete Abdominal Ultrasound | $639$100$954 | $619 | $1,032 |
| Complete Blood Count (CBC) with Differential | $62$43$92 | $125 | $209 |
| Comprehensive Metabolic Panel | $101$72$151 | $448 | $746 |
| Coronary Angioplasty with Stent | $10,719$6.9k$16k | $11,998 | $19,997 |
| Critical Care, First Hour | $6,355$808$9.3k | $2,945 | $4,909 |
| CT Abdomen and Pelvis with Contrast | $3,504$350$5.2k | $3,394 | $5,657 |
| CT Cardiac Calcium Scoring | $85$60$127 | $83 | $138 |
| CT Chest without Contrast | $1,483$100$2.2k | $1,437 | $2,395 |
| CT Head without Contrast | $1,374$100$2.1k | $1,331 | $2,218 |
| DEXA Bone Density Scan | $343$100$512 | $332 | $554 |
| Diagnostic Colonoscopy | $2,370$833$3.5k | $2,600 | $4,333 |
| Diagnostic Mammogram (Both Breasts) | $159$112$238 | $150 | $250 |
| Ear Tube Placement (Tympanostomy) | $4,617$1.4k$6.9k | $4,541 | $7,569 |
| Echocardiogram (Complete with Doppler) | $503 | $1,846 | $3,076 |
| Emergency Room Visit (Level 3) | $2,211$260$3.1k | $1,227 | $2,045 |
| Group Therapy Session | $81 | — | — |
| HIV Antibody Test | $75$53$113 | $143 | $238 |
| Home Sleep Study | $142 | — | — |
| Individual Therapy Session (45 Minutes) | $145 | — | — |
| Inguinal Hernia Repair (Open) | $4,376$3.0k$6.4k | $10,658 | $17,764 |
| Initial Psychiatric Diagnostic Evaluation | $145 | — | — |
| Initial Psychiatric Evaluation with Medication Management | $145 | — | — |
| Intensity-modulated Radiation Therapy (IMRT) Treatment | $1,367$536$2.0k | — | — |
| IUD Insertion | $2,252$1.5k$3.4k | — | — |
| IUD Removal | $4,758$292$7.1k | $589 | $981 |
| Knee Arthroscopy with Meniscectomy | $4,277$2.9k$6.1k | $9,686 | $16,143 |
| Laparoscopic Appendectomy | $8,059$5.3k$12k | $16,436 | $27,393 |
| Laparoscopic Gallbladder Removal | $8,059$5.3k$12k | $16,436 | $27,393 |
| Laparoscopic Tubal Ligation | $8,059$5.3k$12k | $16,436 | $27,393 |
| Lipid Panel (Cholesterol Test) | $95$67$142 | $296 | $494 |
| Lumbar Epidural Steroid Injection | $2,252$630$3.4k | $1,266 | $2,110 |
| Lumbar Puncture (Spinal Tap) | $2,252$630$3.4k | $1,455 | $2,426 |
| Lumbar Spinal Fusion (Posterior) | $8,176$5.8k$17k | $37,066 | $61,776 |
| Lumpectomy (Partial Mastectomy) | $3,256$1.7k$3.7k | $9,998 | $16,664 |
| MRI Abdomen with and without Contrast | $2,478$350$3.7k | $2,400 | $4,000 |
| MRI Brain with and without Contrast | $2,654$350$4.0k | $2,571 | $4,285 |
| MRI Brain with Contrast | $2,171$350$3.2k | $2,103 | $3,505 |
| MRI Brain without Contrast | $1,876$223$2.8k | $1,817 | $3,028 |
| MRI Cervical Spine (Neck) without Contrast | $1,910$223$2.9k | $1,850 | $3,083 |
| MRI Knee without Contrast | $2,109$223$3.1k | $2,043 | $3,405 |
| MRI Lower Back (Lumbar Spine) without Contrast | $1,846$223$2.8k | $1,788 | $2,980 |
| MRI Thoracic Spine (Mid-back) without Contrast | $1,715$223$2.6k | $1,660 | $2,767 |
| Newborn Circumcision | $2,638$1.6k$3.7k | $5,329 | $8,881 |
| Nuclear Cardiac Stress Test | $2,595$1.3k$3.9k | $2,514 | $4,190 |
| Pacemaker Insertion (Dual Chamber) | $10,277$5.7k$20k | $12,214 | $20,356 |
| PET/CT Scan, Whole Body | $2,558$1.4k$3.8k | — | — |
| Pregnancy Ultrasound (Second or Third Trimester) | $299$100$446 | $290 | $483 |
| Prostate Biopsy | $2,252$1.6k$3.4k | $6,362 | $10,604 |
| PSA Prostate Cancer Screening | $93$66$139 | $147 | $245 |
| Pulmonary Function Test with Bronchodilator | $286 | $464 | $774 |
| Rotator Cuff Repair (Arthroscopic) | $8,059$5.7k$12k | $20,528 | $34,214 |
| Screening Mammogram | $130$91$193 | $122 | $203 |
| Septoplasty (Deviated Septum Repair) | $5,846$2.9k$8.7k | $8,052 | $13,420 |
| Sinus Surgery (Endoscopic, with Tissue Removal) | $5,373$3.8k$8.0k | $4,007 | $6,678 |
| Skin Biopsy (Tangential) | $8,059$182$12k | $480 | $800 |
| Skin Lesion Removal (Benign, up to 0.5 cm) | $3,692$1.5k$5.5k | $3,950 | $6,583 |
| Sleep Study (In-lab Polysomnography) | $953 | — | — |
| Spinal Cord Stimulator Trial | $6,216$3.3k$7.7k | $7,785 | $12,975 |
| Spirometry (Breathing Test) | $142 | $249 | $415 |
| Tonsillectomy and Adenoidectomy (Age 12 and Over) | $4,617$2.9k$6.9k | $4,311 | $7,185 |
| Tonsillectomy and Adenoidectomy (Under Age 12) | $3,109$1.6k$5.3k | — | — |
| Total Hip Replacement | $12,266$7.6k$16k | $39,877 | $66,461 |
| Total Knee Replacement | $12,266$7.6k$16k | $37,066 | $61,776 |
| Total Mastectomy | $8,059$4.5k$12k | $17,619 | $29,365 |
| TSH Thyroid Function Test | $100$71$149 | $338 | $564 |
| TURP (Transurethral Prostate Resection) | $5,205$3.4k$7.1k | $13,570 | $22,616 |
| Upper GI Endoscopy (EGD) | $2,370$826$3.5k | $2,723 | $4,538 |
| Urinalysis with Microscopy | $49$34$73 | $127 | $212 |
| Vaginal Birth After Cesarean (VBAC) Global Package | $4,758$3.4k$7.1k | — | — |
| Vaginal Delivery (Global Package) | $4,265$3.0k$6.4k | — | — |
| Vaginal Hysterectomy | $4,486$2.8k$5.9k | $15,056 | $25,093 |
| Vasectomy | $4,265$1.9k$6.4k | $6,209 | $10,348 |
| Vitamin D Blood Test | $118$84$177 | $353 | $588 |