| Arthrocentesis (outpatient) | $1,005 | 44% | $563 | 
Medium |
| Bacterial Culture Swab | $171 | 44% | $96 |
Medium |
| Blood Test - Basic Metabolic Panel | $128 | 44% | $72 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $129 | 44% | $72 |
Medium |
| Blood Test - Clotting Time | $61 | 44% | $34 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $65 | 44% | $36 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $62 | 44% | $35 |
Medium |
| Blood Test - Folic Acid Level | $132 | 44% | $74 |
Medium |
| Blood Test - General Health Panel | $276 | 44% | $155 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $118 | 44% | $66 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $66 | 44% | $37 |
Medium |
| Blood Test - LDL Cholesterol Level | $90 | 44% | $51 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $130 | 44% | $73 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $131 | 44% | $74 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $153 | 44% | $86 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $110 | 44% | $62 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $108 | 44% | $61 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $132 | 44% | $74 |
Medium |
| Blood Test - Vitamin D-3 Level | $242 | 44% | $135 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $4,281 | 44% | $2,397 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $4,885 | 44% | $2,735 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $155 | 44% | $87 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $274 | 44% | $153 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $184 | 44% | $103 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $507 | 44% | $284 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $103 | 44% | $58 |
Medium |
| Mammogram (outpatient) | $1,277 | 44% | $715 |
Medium |
| MRI - Knee (outpatient) | $3,004 | 44% | $1,682 |
Medium |
| Office Visit - Basic | $107 | 44% | $60 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $191 | 44% | $107 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $203 | 44% | $114 |
Medium |
| Office Visit - Established Patient, High Complexity | $236 | 44% | $132 |
Medium |
| Office Visit - Established Patient, Low Complexity | $128 | 44% | $72 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $198 | 44% | $111 |
Medium |
| Office Visit - New Patient, Low Complexity | $196 | 44% | $110 |
Medium |
| Office Visit - New Patient, Minor | $133 | 44% | $75 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $282 | 44% | $158 |
Medium |
| Physical Therapy - Manual Therapy | $128 | 44% | $72 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $376 | 44% | $211 |
Medium |
| Physical Therapy - Re-Evaluation | $188 | 44% | $105 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $129 | 44% | $72 |
Medium |
| Physical Therapy - Therapeutic Activities | $128 | 44% | $72 |
Medium |
| Physical Therapy - Therapeutic Exercises | $125 | 44% | $70 |
Medium |
| Physical Therapy - Ultrasound Therapy | $75 | 44% | $42 |
Medium |
| Strep Test (Streptococcus, group A) | $68 | 44% | $38 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $119 | 44% | $66 |
Medium |
| Ultrasound - Abdominal, Limited | $489 | 44% | $274 |
Medium |
| Ultrasound - Breast (outpatient) | $1,862 | 44% | $1,043 | 
High |
| Ultrasound - Head and Neck | $719 | 44% | $403 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $631 | 44% | $353 |
Medium |
| Urine Test - Automated with Microscope Examination | $57 | 44% | $32 |
Medium |
| Urine Test - Automated without Microscope | $33 | 44% | $18 |
Medium |
| Urine Test - Bacterial Culture | $58 | 44% | $32 |
Medium |
| Urine Test - Chlamydia | $245 | 44% | $137 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $224 | 44% | $125 |
Medium |
| Urine Test - Pregnancy | $68 | 44% | $38 |
Medium |
| X-Ray - Ankle (outpatient) | $452 | 44% | $253 |
Medium |
| X-Ray - Chest (outpatient) | $587 | 44% | $329 |
Medium |
| X-Ray - Foot (outpatient) | $506 | 44% | $283 |
Medium |
| X-Ray - Hand | $655 | 44% | $367 |
Medium |
| X-Ray - Knee (outpatient) | $519 | 44% | $290 |
High |
| X-Ray - Shoulder (outpatient) | $455 | 44% | $255 |
Medium |
| X-Ray - Spine (outpatient) | $413 | 44% | $231 |
Medium |
| X-Ray - Wrist (outpatient) | $505 | 44% | $283 |
High |
