| Arthrocentesis (outpatient) | $1,572 | 53% | $739 |
| Arthroscopic Knee Surgery (outpatient) | $17,563 | 53% | $8,255 |
| Arthroscopic Shoulder Surgery | $29,584 | 53% | $13,905 |
| Bacterial Culture - Aerobic Isolates | $102 | 53% | $48 |
| Bacterial Culture - Swab | $108 | 53% | $51 |
| Biopsy - Breast | $9,846 | 53% | $4,628 |
| Biopsy - Endometrial (Uterus) | $1,122 | 53% | $528 |
| Biopsy - Punch Biopsy of Skin | $1,577 | 53% | $741 |
| Biopsy - Tangential Biopsy of Skin | $1,185 | 53% | $557 |
| Blood Test - Basic Metabolic Panel | $90 | 53% | $42 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $79 | 53% | $37 |
| Blood Test - Cholesterol Test, Lipid Panel | $129 | 53% | $61 |
| Blood Test - Clotting Time | $51 | 53% | $24 |
| Blood Test - Coagulation Assessment | $72 | 53% | $34 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $51 | 53% | $24 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $80 | 53% | $38 |
| Blood Test - Comprehensive Metabolic Panel | $99 | 53% | $46 |
| Blood Test - Electrolytes Panel | $91 | 53% | $43 |
| Blood Test - Ferritin (Blood Protein) Level | $135 | 53% | $64 |
| Blood Test - Folic Acid Level | $131 | 53% | $62 |
| Blood Test - General Health Panel | $310 | 53% | $146 |
| Blood Test - Hepatic (Liver) Function Panel | $98 | 53% | $46 |
| Blood Test - Hepatitis C Antibody Level | $177 | 53% | $83 |
| Blood Test - Iron Level | $65 | 53% | $31 |
| Blood Test - LDL Cholesterol Level | $87 | 53% | $41 |
| Blood Test - Lipase (fat enzyme) Level | $79 | 53% | $37 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $152 | 53% | $72 |
| Blood Test - Renal (Kidney) Function Panel | $76 | 53% | $36 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $131 | 53% | $62 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 53% | $38 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $154 | 53% | $73 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $154 | 53% | $73 |
| Blood Test - Vitamin D-3 Level | $289 | 53% | $136 |
| Bone Density Scan (outpatient) | $886 | 53% | $417 |
| Colonoscopy - Diagnostic (outpatient) | $5,792 | 53% | $2,722 |
| Colonoscopy - With Biopsy (outpatient) | $7,294 | 53% | $3,428 |
| Colonoscopy - With Polyp Removal (outpatient) | $8,324 | 53% | $3,912 |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,530 | 53% | $2,129 |
| CT Scan - Chest, with Contrast (outpatient) | $2,968 | 53% | $1,395 |
| CT Scan - Head/Brain, without Contrast | $2,366 | 53% | $1,112 |
| Cystoscopy | $1,100 | 53% | $517 |
| Detection test for Human Papillomavirus (HPV) | $190 | 53% | $89 |
| Emergency Department Visit - Low Complexity (outpatient) | $478 | 53% | $225 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $856 | 53% | $402 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $111 | 53% | $52 |
| Fetal Non-Stress Test | $1,221 | 53% | $574 |
| Gall Bladder Surgery (outpatient) | $20,145 | 53% | $9,468 |
| Hernia Repair - Laparoscopic (outpatient) | $18,880 | 53% | $8,873 |
| Kidney Stone Removal (outpatient) | $14,684 | 53% | $6,902 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $113 | 53% | $53 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $146 | 53% | $69 |
| Lab Test - Detection test for Influenza Virus | $117 | 53% | $55 |
| Lab Test - Smear for Microorganism | $51 | 53% | $24 |
| Mammogram (outpatient) | $1,198 | 53% | $563 |
| MRI - Back (outpatient) | $3,774 | 53% | $1,774 |
| MRI - Brain (outpatient) | $5,635 | 53% | $2,648 |
| MRI - Knee (outpatient) | $3,721 | 53% | $1,749 |
| MRI - Pelvis (outpatient) | $4,959 | 53% | $2,331 |
| MRI - Shoulder, Elbow, or Wrist | $3,514 | 53% | $1,652 |
| Myocardial Imaging (outpatient) | $6,723 | 53% | $3,160 |
| Office Visit - Established Patient, High Complexity | $307 | 53% | $144 |
| Office Visit - Established Patient, Low Complexity | $154 | 53% | $73 |
| Office Visit - Established Patient, Moderate Complexity | $228 | 53% | $107 |
| Office Visit - New Patient, Low Complexity | $228 | 53% | $107 |
| Office Visit - New Patient, Minor | $159 | 53% | $75 |
| Office Visit - New Patient, Moderate Complexity | $349 | 53% | $164 |
| Pap Test | $202 | 53% | $95 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $117 | 53% | $55 |
| Physical Therapy - Application of Hot or Cold Pack | $32 | 53% | $15 |
| Physical Therapy - High Complexity Evaluation | $296 | 53% | $139 |
| Physical Therapy - Low Complexity Evaluation | $243 | 53% | $114 |
| Physical Therapy - Manual Therapy | $162 | 53% | $76 |
| Physical Therapy - Moderate Complexity Evaluation | $270 | 53% | $127 |
| Physical Therapy - Ultrasound Therapy | $101 | 53% | $47 |
| Strep Test (Streptococcus, group A) | $101 | 53% | $47 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $85 | 53% | $40 |
| Tonsillectomy with Adenoidectomy (outpatient) | $16,927 | 53% | $7,956 |
| Ultrasound - Abdominal, Complete | $1,586 | 53% | $745 |
| Ultrasound - Abdominal, Limited | $1,198 | 53% | $563 |
| Ultrasound - Breast (outpatient) | $2,136 | 53% | $1,004 |
| Ultrasound - Head and Neck | $1,040 | 53% | $489 |
| Ultrasound - Pelvic (outpatient) | $1,218 | 53% | $572 |
| Ultrasound - Pregnancy (outpatient) | $1,483 | 53% | $697 |
| Ultrasound - Pregnancy Follow-Up | $1,175 | 53% | $552 |
| Ultrasound - Transvaginal (non-maternity) | $971 | 53% | $456 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,524 | 53% | $2,596 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $8,111 | 53% | $3,812 |
| Urine Capacity Measurement | $621 | 53% | $292 |
| Urine Test - Automated with Microscope Examination | $63 | 53% | $30 |
| Urine Test - Automated without Microscope | $35 | 53% | $16 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 53% | $40 |
| Urine Test - Chlamydia | $228 | 53% | $107 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $228 | 53% | $107 |
| Urine Test - Microalbumin (Protein) Level | $88 | 53% | $41 |
| Urine Test - Pregnancy | $50 | 53% | $24 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $460 | 53% | $216 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $114 | 53% | $54 |
| X-Ray - Abdomen | $650 | 53% | $305 |
| X-Ray - Ankle (outpatient) | $677 | 53% | $318 |
| X-Ray - Chest (outpatient) | $951 | 53% | $447 |
| X-Ray - Foot (outpatient) | $932 | 53% | $438 |
| X-Ray - Hand | $968 | 53% | $455 |
| X-Ray - Hip | $764 | 53% | $359 |
| X-Ray - Knee (outpatient) | $815 | 53% | $383 |
| X-Ray - Middle Back, Thoracic Spine | $1,002 | 53% | $471 |
| X-Ray - Neck, Cervical Spine | $774 | 53% | $364 |
| X-Ray - Pelvis | $779 | 53% | $366 |
| X-Ray - Shoulder (outpatient) | $798 | 53% | $375 |
| X-Ray - Spine (outpatient) | $881 | 53% | $414 |
| X-Ray - Wrist (outpatient) | $941 | 53% | $442 |
