| Arthrocentesis (outpatient) | $867 | 66% | $295 | 
Medium |
| Biopsy - Breast | $7,366 | 66% | $2,504 |
Medium |
| Blood Test - Basic Metabolic Panel | $72 | 66% | $25 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $84 | 66% | $29 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $133 | 66% | $45 |
Medium |
| Blood Test - Clotting Time | $43 | 66% | $15 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $56 | 66% | $19 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $82 | 66% | $28 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $92 | 66% | $31 |
Medium |
| Blood Test - Electrolytes Panel | $100 | 66% | $34 |
Medium |
| Blood Test - General Health Panel | $332 | 66% | $113 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $74 | 66% | $25 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $128 | 66% | $44 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $78 | 66% | $26 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $158 | 66% | $54 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $97 | 66% | $33 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $141 | 66% | $48 |
Medium |
| Blood Test - Vitamin D-3 Level | $234 | 66% | $80 |
Medium |
| Bone Density Scan (outpatient) | $482 | 66% | $164 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,225 | 66% | $1,436 | 
High |
| Colonoscopy - With Biopsy (outpatient) | $4,216 | 66% | $1,433 |
High |
| Colonoscopy - With Polyp Removal (outpatient) | $4,698 | 66% | $1,597 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,370 | 66% | $1,826 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,579 | 66% | $877 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,930 | 66% | $656 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $460 | 66% | $156 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $224 | 66% | $76 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $822 | 66% | $280 |
Medium |
| Fetal Non-Stress Test | $685 | 66% | $233 |
Medium |
| Gall Bladder Surgery (outpatient) | $25,135 | 66% | $8,546 |
Medium |
| Mammogram (outpatient) | $937 | 66% | $318 |
Medium |
| MRI - Back (outpatient) | $3,466 | 66% | $1,178 |
High |
| MRI - Brain (outpatient) | $5,395 | 66% | $1,834 |
Medium |
| MRI - Knee (outpatient) | $3,385 | 66% | $1,151 |
High |
| Myocardial Imaging (outpatient) | $13,103 | 66% | $4,455 |
High |
| Office Visit - Basic | $147 | 66% | $50 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $217 | 66% | $74 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $232 | 66% | $79 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 66% | $79 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 66% | $92 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $357 | 66% | $121 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $202 | 66% | $69 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $182 | 66% | $62 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $200 | 66% | $68 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $200 | 66% | $68 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $217 | 66% | $74 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $181 | 66% | $61 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $164 | 66% | $56 |
Medium |
| Office Visit - Established Patient, High Complexity | $365 | 66% | $124 |
Medium |
| Office Visit - Established Patient, Low Complexity | $192 | 66% | $65 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $273 | 66% | $93 |
Medium |
| Office Visit - New Patient, Low Complexity | $277 | 66% | $94 |
Medium |
| Office Visit - New Patient, Minor | $200 | 66% | $68 |
Medium |
| Physical Therapy - High Complexity Evaluation | $279 | 66% | $95 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $279 | 66% | $95 |
Medium |
| Physical Therapy - Manual Therapy | $119 | 66% | $40 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $279 | 66% | $95 |
Medium |
| Physical Therapy - Therapeutic Exercises | $119 | 66% | $40 |
Medium |
| Psychiatric Diagnostic Evaluation | $158 | 66% | $54 |
Medium |
| Psychotherapy - 30 Minutes | $133 | 66% | $45 |
Medium |
| Psychotherapy - 45 Minutes | $126 | 66% | $43 |
Medium |
| Psychotherapy - 60 Minutes | $126 | 66% | $43 |
Medium |
| Psychotherapy - Family Session | $146 | 66% | $50 |
Medium |
| Psychotherapy - Group Session | $65 | 66% | $22 |
Medium |
| Strep Test (Streptococcus, group A) | $34 | 66% | $11 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $65 | 66% | $22 |
Medium |
| Ultrasound - Abdominal, Complete | $919 | 66% | $312 |
Medium |
| Ultrasound - Abdominal, Limited | $718 | 66% | $244 |
Medium |
| Ultrasound - Breast (outpatient) | $1,511 | 66% | $514 |
Medium |
| Ultrasound - Head and Neck | $781 | 66% | $266 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $862 | 66% | $293 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $716 | 66% | $243 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $465 | 66% | $158 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,784 | 66% | $1,966 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,735 | 66% | $1,950 |
Medium |
| Urine Test - Automated with Microscope Examination | $72 | 66% | $25 |
Medium |
| Urine Test - Automated without Microscope | $50 | 66% | $17 |
Medium |
| Urine Test - Bacterial Culture | $55 | 66% | $19 |
Medium |
| Urine Test - Pregnancy | $21 | 66% | $7 |
Medium |
| X-Ray - Abdomen | $656 | 66% | $223 |
Medium |
| X-Ray - Ankle (outpatient) | $450 | 66% | $153 |
Medium |
| X-Ray - Chest (outpatient) | $531 | 66% | $181 |
High |
| X-Ray - Foot (outpatient) | $449 | 66% | $153 |
Medium |
| X-Ray - Hand | $494 | 66% | $168 |
Medium |
| X-Ray - Hip | $439 | 66% | $149 |
High |
| X-Ray - Knee (outpatient) | $447 | 66% | $152 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $871 | 66% | $296 |
Medium |
| X-Ray - Neck, Cervical Spine | $553 | 66% | $188 |
Medium |
| X-Ray - Shoulder (outpatient) | $441 | 66% | $150 |
Medium |
| X-Ray - Spine (outpatient) | $512 | 66% | $174 |
Medium |
| X-Ray - Wrist (outpatient) | $425 | 66% | $145 |
Medium |
