| Arthrocentesis (outpatient) | $1,486 | 53% | $713 | 
Medium |
| Arthroscopic Knee Surgery (outpatient) | $14,961 | 53% | $7,181 | 
High |
| Biopsy - Breast | $8,938 | 53% | $4,290 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,172 | 53% | $562 |
Medium |
| Blood Test - Basic Metabolic Panel | $75 | 53% | $36 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $79 | 53% | $38 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $107 | 53% | $51 |
Medium |
| Blood Test - Clotting Time | $51 | 53% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $51 | 53% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $80 | 53% | $38 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $85 | 53% | $41 |
Medium |
| Blood Test - Electrolytes Panel | $76 | 53% | $36 |
Medium |
| Blood Test - General Health Panel | $296 | 53% | $142 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $89 | 53% | $43 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $152 | 53% | $73 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $62 | 53% | $30 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $131 | 53% | $63 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 53% | $39 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $154 | 53% | $74 |
Medium |
| Blood Test - Vitamin D-3 Level | $289 | 53% | $139 |
Medium |
| Bone Density Scan (outpatient) | $839 | 53% | $403 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,729 | 53% | $2,750 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $6,992 | 53% | $3,356 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $8,543 | 53% | $4,100 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,127 | 53% | $1,981 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,457 | 53% | $1,179 |
Medium |
| CT Scan - Head/Brain, without Contrast | $2,015 | 53% | $967 |
Medium |
| Cystoscopy | $1,079 | 53% | $518 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $433 | 53% | $208 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $249 | 53% | $119 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $725 | 53% | $348 |
Medium |
| Fetal Non-Stress Test | $765 | 53% | $367 |
Medium |
| Gall Bladder Surgery (outpatient) | $17,952 | 53% | $8,617 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $20,003 | 53% | $9,601 |
High |
| Kidney Stone Removal (outpatient) | $14,502 | 53% | $6,961 |
Medium |
| Mammogram (outpatient) | $1,057 | 53% | $508 |
Medium |
| MRI - Back (outpatient) | $3,324 | 53% | $1,596 |
Medium |
| MRI - Brain (outpatient) | $5,076 | 53% | $2,437 |
High |
| MRI - Knee (outpatient) | $3,420 | 53% | $1,642 |
High |
| MRI - Pelvis (outpatient) | $4,554 | 53% | $2,186 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $3,214 | 53% | $1,543 |
Medium |
| Myocardial Imaging (outpatient) | $6,491 | 53% | $3,116 |
Medium |
| Office Visit - Basic | $92 | 53% | $44 |
Medium |
| Office Visit - Established Patient, High Complexity | $307 | 53% | $147 |
Medium |
| Office Visit - Established Patient, Low Complexity | $153 | 53% | $74 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $228 | 53% | $109 |
Medium |
| Office Visit - New Patient, Low Complexity | $228 | 53% | $109 |
Medium |
| Office Visit - New Patient, Minor | $159 | 53% | $76 |
Medium |
| Pap Test | $202 | 53% | $97 |
Medium |
| Physical Therapy - High Complexity Evaluation | $296 | 53% | $142 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $243 | 53% | $116 |
Medium |
| Physical Therapy - Manual Therapy | $162 | 53% | $78 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $270 | 53% | $130 |
Medium |
| Physical Therapy - Re-Evaluation | $243 | 53% | $116 |
Medium |
| Physical Therapy - Therapeutic Exercises | $172 | 53% | $83 |
Medium |
| Physical Therapy - Ultrasound Therapy | $101 | 53% | $48 |
Medium |
| Strep Test (Streptococcus, group A) | $81 | 53% | $39 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $68 | 53% | $33 |
Medium |
| Tonsillectomy with Adenoidectomy (outpatient) | $14,974 | 53% | $7,187 |
High |
| Ultrasound - Abdominal, Complete | $1,464 | 53% | $703 |
Medium |
| Ultrasound - Abdominal, Limited | $1,096 | 53% | $526 |
Medium |
| Ultrasound - Breast (outpatient) | $1,484 | 53% | $712 |
Medium |
| Ultrasound - Head and Neck | $939 | 53% | $451 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,177 | 53% | $565 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $1,370 | 53% | $658 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $1,099 | 53% | $528 |
High |
| Ultrasound - Transvaginal (non-maternity) | $786 | 53% | $377 |
High |
| Upper Gastrointestinal Endoscopy - Diagnostic | $4,349 | 53% | $2,088 |
High |
| Upper Gastrointestinal Endoscopy - With Biopsy | $7,049 | 53% | $3,383 |
Medium |
| Urine Capacity Measurement | $525 | 53% | $252 |
Medium |
| Urine Test - Automated with Microscope Examination | $62 | 53% | $30 |
Medium |
| Urine Test - Automated without Microscope | $34 | 53% | $16 |
Medium |
| Urine Test - Bacterial Culture | $68 | 53% | $33 |
Medium |
| Urine Test - Chlamydia | $184 | 53% | $88 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $184 | 53% | $88 |
Medium |
| Urine Test - Pregnancy | $50 | 53% | $24 |
Medium |
| X-Ray - Abdomen | $621 | 53% | $298 |
Medium |
| X-Ray - Ankle (outpatient) | $649 | 53% | $311 |
Medium |
| X-Ray - Chest (outpatient) | $920 | 53% | $442 |
Medium |
| X-Ray - Foot (outpatient) | $737 | 53% | $354 |
Medium |
| X-Ray - Hand | $845 | 53% | $406 |
Medium |
| X-Ray - Hip | $663 | 53% | $318 |
Medium |
| X-Ray - Knee (outpatient) | $729 | 53% | $350 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $827 | 53% | $397 |
High |
| X-Ray - Neck, Cervical Spine | $769 | 53% | $369 |
Medium |
| X-Ray - Pelvis | $1,056 | 53% | $507 |
Medium |
| X-Ray - Shoulder (outpatient) | $709 | 53% | $340 |
Medium |
| X-Ray - Spine (outpatient) | $806 | 53% | $387 |
Medium |
| X-Ray - Wrist (outpatient) | $830 | 53% | $398 |
Medium |
