| Arthrocentesis (outpatient) | $1,461 | 53% | $687 | 
Medium |
| Arthroscopic Knee Surgery (outpatient) | $18,182 | 53% | $8,545 | 
High |
| Bacterial Culture Swab | $108 | 53% | $51 |
Medium |
| Biopsy - Breast | $9,654 | 53% | $4,537 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,198 | 53% | $563 |
High |
| Blood Test - Basic Metabolic Panel | $90 | 53% | $42 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $79 | 53% | $37 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $129 | 53% | $61 |
Medium |
| Blood Test - Clotting Time | $51 | 53% | $24 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $51 | 53% | $24 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $80 | 53% | $38 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $99 | 53% | $46 |
Medium |
| Blood Test - Electrolytes Panel | $91 | 53% | $43 |
Medium |
| Blood Test - Folic Acid Level | $131 | 53% | $62 |
Medium |
| Blood Test - General Health Panel | $306 | 53% | $144 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $98 | 53% | $46 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $177 | 53% | $83 |
Medium |
| Blood Test - LDL Cholesterol Level | $87 | 53% | $41 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $79 | 53% | $37 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $152 | 53% | $72 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $76 | 53% | $36 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $131 | 53% | $62 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 53% | $38 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $154 | 53% | $73 |
Medium |
| Blood Test - Vitamin D-3 Level | $289 | 53% | $136 |
Medium |
| Bone Density Scan (outpatient) | $886 | 53% | $417 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,728 | 53% | $2,692 |
High |
| Colonoscopy - With Biopsy (outpatient) | $7,141 | 53% | $3,356 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $8,312 | 53% | $3,907 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,430 | 53% | $2,082 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,610 | 53% | $1,227 |
Medium |
| CT Scan - Head/Brain, without Contrast | $2,207 | 53% | $1,037 |
Medium |
| Cystoscopy | $1,079 | 53% | $507 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $190 | 53% | $89 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $478 | 53% | $225 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $286 | 53% | $134 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $856 | 53% | $402 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $111 | 53% | $52 |
Medium |
| Fetal Non-Stress Test | $839 | 53% | $394 |
High |
| Gall Bladder Surgery (outpatient) | $18,942 | 53% | $8,903 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $19,253 | 53% | $9,049 |
High |
| Kidney Stone Removal (outpatient) | $14,424 | 53% | $6,779 |
Medium |
| Mammogram (outpatient) | $1,198 | 53% | $563 |
Medium |
| MRI - Back (outpatient) | $3,578 | 53% | $1,682 |
Medium |
| MRI - Brain (outpatient) | $5,459 | 53% | $2,566 |
Medium |
| MRI - Knee (outpatient) | $3,721 | 53% | $1,749 |
Medium |
| MRI - Pelvis (outpatient) | $4,802 | 53% | $2,257 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $3,498 | 53% | $1,644 |
Medium |
| Myocardial Imaging (outpatient) | $6,723 | 53% | $3,160 |
Medium |
| Office Visit - Established Patient, High Complexity | $307 | 53% | $144 |
Medium |
| Office Visit - Established Patient, Low Complexity | $153 | 53% | $72 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $228 | 53% | $107 |
Medium |
| Office Visit - New Patient, Low Complexity | $228 | 53% | $107 |
Medium |
| Office Visit - New Patient, Minor | $159 | 53% | $75 |
Medium |
| Pap Test | $202 | 53% | $95 |
Medium |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $117 | 53% | $55 |
Medium |
| Physical Therapy - Application of Hot or Cold Pack | $32 | 53% | $15 |
Medium |
| Physical Therapy - High Complexity Evaluation | $296 | 53% | $139 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $243 | 53% | $114 |
Medium |
| Physical Therapy - Manual Therapy | $162 | 53% | $76 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $270 | 53% | $127 |
Medium |
| Physical Therapy - Re-Evaluation | $243 | 53% | $114 |
Medium |
| Physical Therapy - Therapeutic Exercises | $172 | 53% | $81 |
Medium |
| Physical Therapy - Ultrasound Therapy | $101 | 53% | $47 |
Medium |
| Strep Test (Streptococcus, group A) | $92 | 53% | $43 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $85 | 53% | $40 |
Medium |
| Tonsillectomy with Adenoidectomy (outpatient) | $15,434 | 53% | $7,254 |
High |
| Ultrasound - Abdominal, Complete | $1,586 | 53% | $745 |
Medium |
| Ultrasound - Abdominal, Limited | $1,198 | 53% | $563 |
Medium |
| Ultrasound - Breast (outpatient) | $1,911 | 53% | $898 |
Medium |
| Ultrasound - Head and Neck | $1,040 | 53% | $489 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,177 | 53% | $553 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $1,444 | 53% | $679 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $1,175 | 53% | $552 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,115 | 53% | $524 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $4,321 | 53% | $2,031 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $7,574 | 53% | $3,560 |
Medium |
| Urine Capacity Measurement | $557 | 53% | $262 |
Medium |
| Urine Test - Automated with Microscope Examination | $62 | 53% | $29 |
Medium |
| Urine Test - Automated without Microscope | $35 | 53% | $16 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | 53% | $40 |
Medium |
| Urine Test - Chlamydia | $228 | 53% | $107 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $228 | 53% | $107 |
Medium |
| Urine Test - Pregnancy | $50 | 53% | $24 |
Medium |
| X-Ray - Abdomen | $650 | 53% | $305 |
Medium |
| X-Ray - Ankle (outpatient) | $676 | 53% | $318 |
Medium |
| X-Ray - Chest (outpatient) | $930 | 53% | $437 |
Medium |
| X-Ray - Foot (outpatient) | $850 | 53% | $399 |
Medium |
| X-Ray - Hand | $920 | 53% | $432 |
Medium |
| X-Ray - Hip | $690 | 53% | $324 |
Medium |
| X-Ray - Knee (outpatient) | $748 | 53% | $351 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $1,005 | 53% | $472 |
High |
| X-Ray - Neck, Cervical Spine | $747 | 53% | $351 |
Medium |
| X-Ray - Pelvis | $867 | 53% | $408 |
Medium |
| X-Ray - Shoulder (outpatient) | $769 | 53% | $361 |
Medium |
| X-Ray - Spine (outpatient) | $881 | 53% | $414 |
Medium |
| X-Ray - Wrist (outpatient) | $900 | 53% | $423 |
Medium |
