Acne |
Medium Cost |
Adenoid and Tonsil Removal |
Higher Cost |
Adenoid Removal |
Higher Cost |
Allergy/Runny Nose |
Higher Cost |
Appendectomy |
Medium Cost |
Asthma, without complications |
Higher Cost |
Atrial Fibrillation and Flutter |
Higher Cost |
Back Sprain/Strain |
Higher Cost |
Bladder Scope (Cystoscopy) |
Higher Cost |
Bone Density Dexa Scan |
Higher Cost |
Bronchitis, acute |
Higher Cost |
Bunion Surgery |
Higher Cost |
Bursitis and Tendinitis |
Higher Cost |
Cardiac Catheterization, diagnostic |
Higher Cost |
Carpal Tunnel Surgery |
Medium Cost |
Cataract Removal, Implant Artificial Lens |
Medium Cost |
Cataract, without surgery |
Higher Cost |
Chronic Obstructive Pulmonary Disease |
Medium Cost |
Colonoscopy, without biopsy |
Medium Cost |
Contact Dermatitis |
Medium Cost |
Contraceptive Drug Management |
Medium Cost |
Coronary Artery Catheterization w/ Drug Stent |
Medium Cost |
CT Scan - Neck (Cervical Spine), without contrast |
Higher Cost |
CT Scan - Abdomen and Pelvis, with contrast |
Higher Cost |
CT Scan - Abdomen and Pelvis, without contrast |
Higher Cost |
CT Scan - Abdomen, with contrast |
Medium Cost |
CT Scan - Chest, with contrast |
Medium Cost |
CT Scan - Chest, without contrast |
Higher Cost |
CT Scan - Face and Jaw (Maxillofacial Area), without contrast |
Higher Cost |
CT Scan - Head, without contrast |
Medium Cost |
CT Scan - Lower Extremity, without contrast |
Medium Cost |
CT Scan - Neck, soft tissue, with contrast |
Higher Cost |
CT Scan - Upper Extremity, without contrast |
Medium Cost |
Diabetes, insulin dependent |
Medium Cost |
Diabetes, noninsulin dependent |
Medium Cost |
Diverticulitis and Inflammatory Bowel Disease |
Higher Cost |
Ear Infection, middle ear |
Higher Cost |
Ear Infection, with minor surgery |
Medium Cost |
Ear Tubes and Eardrum Drainage |
Medium Cost |
Echo Heart Exam, Doppler |
Higher Cost |
Epilepsy |
Medium Cost |
Esophagus Inflammation |
Higher Cost |
Eye Problems, Visual Disturbances |
Higher Cost |
Foot/Ankle Dislocation/Fracture |
Higher Cost |
Foot/Ankle Sprain/Strain |
Higher Cost |
Gallbladder Removal, laparoscopic |
Medium Cost |
Genitourinary Infections, nonsexually transmitted |
Higher Cost |
Glaucoma (Open-Angle), without surgery |
Higher Cost |
Gout |
Medium Cost |
Hand/Wrist/Forearm Dislocation/Fracture |
Higher Cost |
Headache, migraine |
Medium Cost |
Hearing Disorders |
Medium Cost |
Heart Disease, Ischemic |
Higher Cost |
Hemorrhoids |
Higher Cost |
Hernia Repair, Inguinal (Groin) |
Higher Cost |
Hernia Repair, Umbilical |
Higher Cost |
Hernia, inguinal (total cost) |
Higher Cost |
High Blood Pressure (Hypertension) |
Higher Cost |
High Cholesterol/High Triglyceride (Hyperlipidemia) |
Higher Cost |
Hysterectomy, Vaginal |
Higher Cost |
Hysteroscopy |
Higher Cost |
Incontinence, Urinary |
Medium Cost |
Inflammatory Eye Disease (Uveitis) |
Higher Cost |
Irritable Bowel Syndrome |
Medium Cost |
Joint Degeneration, back, without surgery |
Medium Cost |
Joint Degeneration, foot and ankle, without surgery |
Higher Cost |
Joint Degeneration, hand, wrist, forearm, without surgery |
Higher Cost |
Joint Degeneration, knee and lower leg |
Medium Cost |
Joint Degeneration, neck |
Medium Cost |
Joint Degeneration, shoulder, without surgery |
Medium Cost |
Joint Degeneration, thigh, hip and pelvis |
Medium Cost |
Knee Surgery, arthroscopic, with meniscectomy |
Higher Cost |
Laminectomy |
Higher Cost |
Lung Infection, bacterial |
Higher Cost |
Mammogram, screening, digital |
Higher Cost |
Menstrual Conditions, without surgery |
Higher Cost |
MRI - Abdomen, with and without contrast |
Higher Cost |
MRI - Back (Lumbar Spine), with contrast |
Higher Cost |
MRI - Brain with and without contrast |
Higher Cost |
MRI - Brain, without contrast |
Higher Cost |
MRI - Chest, with contrast |
Higher Cost |
MRI - Chest, without contrast |
Higher Cost |
MRI - Lower Extremity, with contrast |
Higher Cost |
MRI - Lower Extremity, without contrast |
Higher Cost |
MRI - Neck (Cervical Spine), with contrast |
Higher Cost |
MRI - Neck (Cervical Spine), without contrast |
Higher Cost |
MRI - Neck (Soft Tissue), with contrast |
Higher Cost |
MRI - Pelvis, with and without contrast |
Higher Cost |
MRI - Pelvis, without contrast |
Higher Cost |
MRI - Spine, without contrast |
Higher Cost |
MRI - Upper Extremity, with contrast |
Medium Cost |
MRI - Upper Extremity, without contrast |
Higher Cost |
Nutritional Deficiency |
Higher Cost |
Orthopedic Deformity, foot and ankle |
Medium Cost |
Osteoporosis |
Higher Cost |
PET/CT Scan - Mid-body |
Higher Cost |
Pinkeye (Conjunctivitis) |
Medium Cost |
Pneumonia, viral |
Higher Cost |
Psoriasis |
Higher Cost |
Rheumatoid Arthritis |
Higher Cost |
Rotator Cuff Repair, arthroscopic |
Higher Cost |
Routine Exam |
Higher Cost |
Sinusitis, acute |
Higher Cost |
Skin Infection, bacterial, minor |
Higher Cost |
Skin Infection, fungal |
Higher Cost |
Skin Infection, viral |
Higher Cost |
Skin Inflammation, minor |
Higher Cost |
Sore Throat and Tonsillitis/Adenoiditis, without surgery |
Higher Cost |
Strabismus Revision |
Higher Cost |
Thyroid Disease, hyper-functioning |
Higher Cost |
Thyroid Disease, hypothyroidism |
Higher Cost |
Tonsil Removal (Tonsillectomy) |
Higher Cost |
Tonsillitis, Adenoiditis, Pharyngitis (sore throat), without surgery |
Higher Cost |
Tumor Removal, Breast, non-cancerous |
Medium Cost |
Tumor Removal, Female Reproductive Tract, non-cancerous |
Higher Cost |
Tumor Removal, Prostate, non-cancerous |
Medium Cost |
Ultrasound - Abdomen |
Higher Cost |
Ultrasound - Breast |
Higher Cost |
Ultrasound - Head and Neck |
Higher Cost |
Ultrasound - Kidney |
Higher Cost |
Ultrasound - Pelvic |
Higher Cost |
Ultrasound - Scrotum |
Higher Cost |
Ultrasound - Transabdominal, first trimester |
Higher Cost |
Ultrasound - Transvaginal (across vaginal area) |
Higher Cost |
Upper GI Endoscopy |
Medium Cost |
Vaginal Infection |
Medium Cost |
Vasectomy |
Medium Cost |
Wrist Sprain/Strain |
Higher Cost |
X-ray - Ankle |
Higher Cost |
X-ray - Chest |
Higher Cost |
X-Ray - Collar Bone |
Higher Cost |
X-ray - Elbow |
Higher Cost |
X-ray - Finger(s) |
Higher Cost |
X-ray - Foot |
Higher Cost |
X-ray - Forearm |
Higher Cost |
X-ray - Hand |
Higher Cost |
X-ray - Hip |
Higher Cost |
X-ray - Knee |
Higher Cost |
X-ray - Neck (Cervical Spine) |
Higher Cost |
X-ray - Pelvis |
Higher Cost |
X-ray - Shoulder |
Higher Cost |
X-ray - Spine |
Higher Cost |
X-ray - Wrist |
Higher Cost |