| Arthrocentesis (outpatient) | $698 | 65% | $419 | 
Medium |
| Blood Test - Basic Metabolic Panel | $158 | 65% | $95 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $105 | 65% | $63 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $149 | 65% | $90 |
Medium |
| Blood Test - Clotting Time | $12 | 65% | $7 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $97 | 65% | $58 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $105 | 65% | $63 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $201 | 65% | $121 |
Medium |
| Blood Test - Electrolytes Panel | $78 | 65% | $47 |
Medium |
| Blood Test - General Health Panel | $75 | 65% | $45 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $167 | 65% | $100 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $93 | 65% | $56 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $140 | 65% | $84 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $141 | 65% | $84 |
Medium |
| Blood Test - Vitamin D-3 Level | $201 | 65% | $120 |
Medium |
| Bone Density Scan (outpatient) | $599 | 65% | $359 | 
High |
| Colonoscopy - Diagnostic (outpatient) | $4,015 | 65% | $2,409 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $4,890 | 65% | $2,934 |
High |
| Colonoscopy - With Polyp Removal (outpatient) | $5,924 | 65% | $3,554 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,471 | 65% | $1,483 |
Medium |
| Destruction of Lesion (outpatient) | $343 | 65% | $206 |
High |
| Emergency Department Visit - Low Complexity (outpatient) | $365 | 65% | $219 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $213 | 65% | $128 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $548 | 65% | $329 |
Medium |
| Fetal Non-Stress Test | $944 | 65% | $566 |
Medium |
| Mammogram (outpatient) | $737 | 65% | $442 |
Medium |
| MRI - Back (outpatient) | $3,119 | 65% | $1,871 |
High |
| MRI - Brain (outpatient) | $6,830 | 65% | $4,098 |
Medium |
| MRI - Knee (outpatient) | $3,132 | 65% | $1,879 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $3,086 | 65% | $1,852 |
Medium |
| Office Visit - Basic | $78 | 65% | $47 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $252 | 65% | $151 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $264 | 65% | $158 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $271 | 65% | $163 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $318 | 65% | $191 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $249 | 65% | $149 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $232 | 65% | $139 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $210 | 65% | $126 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $229 | 65% | $137 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $230 | 65% | $138 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $252 | 65% | $151 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $208 | 65% | $125 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $188 | 65% | $113 |
Medium |
| Office Visit - Established Patient, High Complexity | $256 | 65% | $154 |
Medium |
| Office Visit - Established Patient, Low Complexity | $126 | 65% | $76 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $189 | 65% | $113 |
Medium |
| Office Visit - New Patient, Low Complexity | $191 | 65% | $115 |
Medium |
| Office Visit - New Patient, Minor | $130 | 65% | $78 |
Medium |
| Pap Test | $225 | 65% | $135 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $77 | 65% | $46 |
Medium |
| Physical Therapy - High Complexity Evaluation | $359 | 65% | $215 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $198 | 65% | $119 |
Medium |
| Physical Therapy - Manual Therapy | $82 | 65% | $49 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $291 | 65% | $175 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $69 | 65% | $42 |
Medium |
| Physical Therapy - Therapeutic Activities | $67 | 65% | $40 |
Medium |
| Physical Therapy - Therapeutic Exercises | $66 | 65% | $40 |
Medium |
| Physical Therapy - Ultrasound Therapy | $69 | 65% | $42 |
Medium |
| Strep Test (Streptococcus, group A) | $34 | 65% | $20 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $105 | 65% | $63 |
Medium |
| Ultrasound - Abdominal, Limited | $475 | 65% | $285 |
Medium |
| Ultrasound - Breast (outpatient) | $737 | 65% | $442 |
Medium |
| Ultrasound - Head and Neck | $976 | 65% | $586 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $557 | 65% | $334 | 
Low |
| Ultrasound - Pregnancy Follow-Up | $433 | 65% | $260 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,133 | 65% | $680 |
Medium |
| Urine Test - Automated with Microscope Examination | $38 | 65% | $23 |
Medium |
| Urine Test - Automated without Microscope | $55 | 65% | $33 |
Medium |
| Urine Test - Bacterial Culture | $107 | 65% | $64 |
Medium |
| Urine Test - Chlamydia | $211 | 65% | $127 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $196 | 65% | $118 |
Medium |
| Urine Test - Pregnancy | $19 | 65% | $11 |
Medium |
| X-Ray - Ankle (outpatient) | $501 | 65% | $301 |
Medium |
| X-Ray - Chest (outpatient) | $553 | 65% | $332 |
Medium |
| X-Ray - Foot (outpatient) | $553 | 65% | $332 |
Medium |
| X-Ray - Hand | $746 | 65% | $447 |
Medium |
| X-Ray - Hip | $576 | 65% | $346 |
Medium |
| X-Ray - Knee (outpatient) | $736 | 65% | $441 |
Medium |
| X-Ray - Neck, Cervical Spine | $507 | 65% | $304 |
Medium |
| X-Ray - Pelvis | $365 | 65% | $219 |
High |
| X-Ray - Shoulder (outpatient) | $654 | 65% | $392 |
Medium |
| X-Ray - Spine (outpatient) | $695 | 65% | $417 |
Medium |
| X-Ray - Wrist (outpatient) | $712 | 65% | $427 |
Medium |
