| Arthrocentesis (outpatient) | $1,675 | 65% | $586 | 
High |
| Arthroscopic Knee Surgery (outpatient) | $14,164 | 65% | $4,958 |
High |
| Arthroscopic Shoulder Surgery | $27,234 | 65% | $9,532 |
High |
| Biopsy - Breast | $8,198 | 65% | $2,869 | 
Medium |
| Biopsy - Endometrial (Uterus) | $1,454 | 65% | $509 |
Medium |
| Blood Test - Basic Metabolic Panel | $168 | 65% | $59 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $83 | 65% | $29 |
Medium |
| Blood Test - Clotting Time | $34 | 65% | $12 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $84 | 65% | $29 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 65% | $23 |
Medium |
| Blood Test - Electrolytes Panel | $90 | 65% | $31 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $154 | 65% | $54 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $407 | 65% | $143 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $168 | 65% | $59 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $144 | 65% | $50 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 65% | $28 |
Medium |
| Blood Test - Vitamin D-3 Level | $278 | 65% | $97 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $6,387 | 65% | $2,235 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $7,940 | 65% | $2,779 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $8,643 | 65% | $3,025 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,210 | 65% | $1,823 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,359 | 65% | $1,176 |
Medium |
| CT Scan - Head/Brain, without Contrast | $1,715 | 65% | $600 |
Medium |
| Cystoscopy | $1,339 | 65% | $469 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $324 | 65% | $114 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $212 | 65% | $74 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $562 | 65% | $197 |
Medium |
| Fetal Non-Stress Test | $974 | 65% | $341 |
Medium |
| Gall Bladder Surgery (outpatient) | $15,608 | 65% | $5,463 |
High |
| Hernia Repair - Laparoscopic (outpatient) | $15,875 | 65% | $5,556 |
High |
| Mammogram (outpatient) | $1,012 | 65% | $354 |
Medium |
| MRI - Back (outpatient) | $3,784 | 65% | $1,324 |
Medium |
| MRI - Brain (outpatient) | $7,432 | 65% | $2,601 |
Medium |
| MRI - Knee (outpatient) | $2,566 | 65% | $898 |
Medium |
| MRI - Pelvis (outpatient) | $5,163 | 65% | $1,807 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,566 | 65% | $898 |
Medium |
| Myocardial Imaging (outpatient) | $9,914 | 65% | $3,470 |
Medium |
| Pap Test | $179 | 65% | $62 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $79 | 65% | $28 |
Medium |
| Physical Therapy - Manual Therapy | $134 | 65% | $47 |
Medium |
| Physical Therapy - Therapeutic Activities | $134 | 65% | $47 |
Medium |
| Physical Therapy - Therapeutic Exercises | $134 | 65% | $47 |
Medium |
| Psychiatric Diagnostic Evaluation | $246 | 65% | $86 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $59 | 65% | $21 |
Medium |
| Ultrasound - Abdominal, Complete | $1,146 | 65% | $401 |
Medium |
| Ultrasound - Abdominal, Limited | $920 | 65% | $322 |
Medium |
| Ultrasound - Breast (outpatient) | $613 | 65% | $214 |
Medium |
| Ultrasound - Head and Neck | $921 | 65% | $322 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,093 | 65% | $383 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $967 | 65% | $338 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $6,091 | 65% | $2,132 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $7,875 | 65% | $2,756 |
Medium |
| Urine Capacity Measurement | $675 | 65% | $236 |
Medium |
| Urine Test - Automated with Microscope Examination | $51 | 65% | $18 |
Medium |
| Urine Test - Automated without Microscope | $25 | 65% | $9 |
Medium |
| Urine Test - Bacterial Culture | $124 | 65% | $43 |
Medium |
| Urine Test - Chlamydia | $160 | 65% | $56 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $160 | 65% | $56 |
Medium |
| Urine Test - Pregnancy | $112 | 65% | $39 |
Medium |
| X-Ray - Abdomen | $699 | 65% | $245 |
Medium |
| X-Ray - Ankle (outpatient) | $643 | 65% | $225 |
Medium |
| X-Ray - Chest (outpatient) | $852 | 65% | $298 |
Medium |
| X-Ray - Foot (outpatient) | $749 | 65% | $262 |
Medium |
| X-Ray - Hand | $844 | 65% | $295 |
High |
| X-Ray - Hip | $779 | 65% | $273 |
High |
| X-Ray - Knee (outpatient) | $789 | 65% | $276 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $898 | 65% | $314 |
High |
| X-Ray - Neck, Cervical Spine | $828 | 65% | $290 |
Medium |
| X-Ray - Pelvis | $545 | 65% | $191 |
Medium |
| X-Ray - Shoulder (outpatient) | $831 | 65% | $291 |
Medium |
| X-Ray - Spine (outpatient) | $825 | 65% | $289 |
Medium |
| X-Ray - Wrist (outpatient) | $652 | 65% | $228 |
High |
