| Arthrocentesis (outpatient) | $956 | 68% | $306 | 
Medium |
| Bacterial Culture Swab | $146 | 68% | $47 |
Medium |
| Biopsy - Breast | $7,378 | 68% | $2,361 |
Medium |
| Blood Test - Basic Metabolic Panel | $76 | 68% | $24 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $84 | 68% | $27 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $138 | 68% | $44 |
Medium |
| Blood Test - Clotting Time | $43 | 68% | $14 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | 68% | $22 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $82 | 68% | $26 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $92 | 68% | $30 |
Medium |
| Blood Test - Electrolytes Panel | $100 | 68% | $32 |
Medium |
| Blood Test - Folic Acid Level | $137 | 68% | $44 |
Medium |
| Blood Test - General Health Panel | $337 | 68% | $108 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $86 | 68% | $28 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $117 | 68% | $37 |
Medium |
| Blood Test - LDL Cholesterol Level | $81 | 68% | $26 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $104 | 68% | $33 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $145 | 68% | $46 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $95 | 68% | $30 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $148 | 68% | $47 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $117 | 68% | $37 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $147 | 68% | $47 |
Medium |
| Blood Test - Vitamin D-3 Level | $234 | 68% | $75 |
Medium |
| Bone Density Scan (outpatient) | $576 | 68% | $184 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $3,736 | 68% | $1,195 | 
High |
| Colonoscopy - With Biopsy (outpatient) | $4,250 | 68% | $1,360 |
High |
| Colonoscopy - With Polyp Removal (outpatient) | $4,818 | 68% | $1,542 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,310 | 68% | $1,699 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,579 | 68% | $825 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,895 | 68% | $606 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $342 | 68% | $110 |
Medium |
| Electrocardiogram (ECG or EKG) | $578 | 68% | $185 |
High |
| Emergency Department Visit - Low Complexity (outpatient) | $470 | 68% | $151 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $224 | 68% | $72 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $961 | 68% | $307 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $137 | 68% | $44 |
Medium |
| Fetal Non-Stress Test | $690 | 68% | $221 |
Medium |
| Gall Bladder Surgery (outpatient) | $25,364 | 68% | $8,116 |
Medium |
| Mammogram (outpatient) | $962 | 68% | $308 |
Medium |
| MRI - Back (outpatient) | $3,599 | 68% | $1,152 |
Medium |
| MRI - Brain (outpatient) | $5,550 | 68% | $1,776 |
Medium |
| MRI - Knee (outpatient) | $3,385 | 68% | $1,083 |
High |
| Myocardial Imaging (outpatient) | $13,276 | 68% | $4,248 |
Medium |
| Office Visit - Basic | $111 | 68% | $36 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 68% | $74 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 68% | $86 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $207 | 68% | $66 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | 68% | $61 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $200 | 68% | $64 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $203 | 68% | $65 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $228 | 68% | $73 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | 68% | $61 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $164 | 68% | $52 |
Medium |
| Office Visit - Established Patient, High Complexity | $359 | 68% | $115 |
Medium |
| Office Visit - Established Patient, Low Complexity | $182 | 68% | $58 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $263 | 68% | $84 |
Medium |
| Office Visit - New Patient, Low Complexity | $268 | 68% | $86 |
Medium |
| Office Visit - New Patient, Minor | $200 | 68% | $64 |
Medium |
| Physical Therapy - High Complexity Evaluation | $303 | 68% | $97 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $327 | 68% | $104 |
Medium |
| Physical Therapy - Manual Therapy | $139 | 68% | $44 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $327 | 68% | $104 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $139 | 68% | $44 |
Medium |
| Physical Therapy - Therapeutic Activities | $135 | 68% | $43 |
Medium |
| Physical Therapy - Therapeutic Exercises | $133 | 68% | $43 |
Medium |
| Physical Therapy - Ultrasound Therapy | $119 | 68% | $38 |
Medium |
| Psychiatric Diagnostic Evaluation | $168 | 68% | $54 |
Medium |
| Psychotherapy - 30 Minutes | $133 | 68% | $43 |
Medium |
| Psychotherapy - 45 Minutes | $126 | 68% | $40 |
Medium |
| Psychotherapy - 60 Minutes | $137 | 68% | $44 |
Medium |
| Psychotherapy - Family Session | $146 | 68% | $47 |
Medium |
| Psychotherapy - Group Session | $65 | 68% | $21 |
Medium |
| Strep Test (Streptococcus, group A) | $41 | 68% | $13 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $79 | 68% | $25 |
Medium |
| Ultrasound - Abdominal, Complete | $1,158 | 68% | $371 |
Medium |
| Ultrasound - Abdominal, Limited | $906 | 68% | $290 |
Medium |
| Ultrasound - Breast (outpatient) | $1,511 | 68% | $484 |
High |
| Ultrasound - Head and Neck | $828 | 68% | $265 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $938 | 68% | $300 | 
Low |
| Ultrasound - Pregnancy Follow-Up | $695 | 68% | $222 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $622 | 68% | $199 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $6,795 | 68% | $2,174 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,866 | 68% | $2,197 |
Medium |
| Urine Test - Automated with Microscope Examination | $72 | 68% | $23 |
Medium |
| Urine Test - Automated without Microscope | $42 | 68% | $13 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $66 | 68% | $21 |
Medium |
| Urine Test - Pregnancy | $23 | 68% | $7 |
Medium |
| X-Ray - Abdomen | $541 | 68% | $173 |
Medium |
| X-Ray - Ankle (outpatient) | $443 | 68% | $142 |
Medium |
| X-Ray - Chest (outpatient) | $517 | 68% | $165 |
Medium |
| X-Ray - Foot (outpatient) | $449 | 68% | $144 |
High |
| X-Ray - Hand | $491 | 68% | $157 |
Medium |
| X-Ray - Hip | $439 | 68% | $140 |
Medium |
| X-Ray - Knee (outpatient) | $402 | 68% | $129 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $823 | 68% | $263 |
High |
| X-Ray - Neck, Cervical Spine | $589 | 68% | $188 |
Medium |
| X-Ray - Shoulder (outpatient) | $426 | 68% | $136 |
Medium |
| X-Ray - Spine (outpatient) | $595 | 68% | $191 |
Medium |
| X-Ray - Wrist (outpatient) | $427 | 68% | $137 |
Medium |
