| Ambulance Service - Emergency Transport, Advanced Life Support | $987 | 50% | $494 | 
Medium |
| Ambulance Service - Emergency Transport, Basic Life Support | $905 | 50% | $453 |
Medium |
| Ambulance Service - Mileage Rate for Ambulance Transport | $22 | 50% | $11 |
Medium |
| Arthrocentesis (outpatient) | $389 | 50% | $195 |
Medium |
| Arthroscopic Knee Surgery (outpatient) | $14,309 | 50% | $7,154 |
Medium |
| Blood Test - Basic Metabolic Panel | $159 | 50% | $79 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 50% | $45 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $155 | 50% | $77 |
Medium |
| Blood Test - Clotting Time | $50 | 50% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $56 | 50% | $28 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $89 | 50% | $45 |
Medium |
| Blood Test - Electrolytes Panel | $102 | 50% | $51 |
Medium |
| Blood Test - General Health Panel | $61 | 50% | $30 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $61 | 50% | $30 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $107 | 50% | $54 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $158 | 50% | $79 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $190 | 50% | $95 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $104 | 50% | $52 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $116 | 50% | $58 |
Medium |
| Blood Test - Vitamin D-3 Level | $216 | 50% | $108 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $3,042 | 50% | $1,521 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,980 | 50% | $2,990 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $4,944 | 50% | $2,472 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,229 | 50% | $1,614 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,615 | 50% | $1,307 |
Medium |
| CT Scan - Head/Brain, without Contrast | $2,448 | 50% | $1,224 |
Medium |
| Destruction of Lesion (outpatient) | $456 | 50% | $228 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $356 | 50% | $178 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $202 | 50% | $101 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $553 | 50% | $277 |
Medium |
| Fetal Non-Stress Test | $1,027 | 50% | $513 |
Medium |
| Gall Bladder Surgery (outpatient) | $22,704 | 50% | $11,352 |
Medium |
| Mammogram (outpatient) | $1,072 | 50% | $536 |
Medium |
| MRI - Back (outpatient) | $2,895 | 50% | $1,447 | 
High |
| MRI - Brain (outpatient) | $5,443 | 50% | $2,722 |
Medium |
| MRI - Knee (outpatient) | $2,869 | 50% | $1,434 |
Medium |
| MRI - Pelvis (outpatient) | $5,423 | 50% | $2,712 |
High |
| MRI - Shoulder, Elbow, or Wrist | $3,582 | 50% | $1,791 |
High |
| Myocardial Imaging (outpatient) | $5,652 | 50% | $2,826 |
Medium |
| Office Visit - Basic | $142 | 50% | $71 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $264 | 50% | $132 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $309 | 50% | $154 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $300 | 50% | $150 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $347 | 50% | $173 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $273 | 50% | $137 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $251 | 50% | $125 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $240 | 50% | $120 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $264 | 50% | $132 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $269 | 50% | $134 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $288 | 50% | $144 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $239 | 50% | $120 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $226 | 50% | $113 |
Medium |
| Office Visit - Established Patient, High Complexity | $330 | 50% | $165 |
Medium |
| Office Visit - Established Patient, Low Complexity | $167 | 50% | $83 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $244 | 50% | $122 |
Medium |
| Office Visit - New Patient, Low Complexity | $245 | 50% | $122 |
Medium |
| Office Visit - New Patient, Minor | $169 | 50% | $85 |
Medium |
| Pap Test | $126 | 50% | $63 |
Medium |
| Physical Therapy - High Complexity Evaluation | $440 | 50% | $220 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $204 | 50% | $102 |
Medium |
| Physical Therapy - Manual Therapy | $119 | 50% | $59 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $315 | 50% | $158 |
Medium |
| Physical Therapy - Therapeutic Activities | $119 | 50% | $59 |
Medium |
| Physical Therapy - Therapeutic Exercises | $119 | 50% | $59 |
Medium |
| Psychiatric Diagnostic Evaluation | $137 | 50% | $68 |
Medium |
| Psychotherapy - 30 Minutes | $89 | 50% | $45 |
Medium |
| Psychotherapy - 45 Minutes | $112 | 50% | $56 |
Medium |
| Psychotherapy - 60 Minutes | $158 | 50% | $79 |
Medium |
| Strep Test (Streptococcus, group A) | $49 | 50% | $25 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $50 | 50% | $25 |
Medium |
| Ultrasound - Abdominal, Complete | $1,305 | 50% | $653 |
Medium |
| Ultrasound - Abdominal, Limited | $702 | 50% | $351 |
Medium |
| Ultrasound - Head and Neck | $834 | 50% | $417 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $834 | 50% | $417 | 
Low |
| Ultrasound - Pregnancy Follow-Up | $1,889 | 50% | $944 |
Medium |
| Upper Gastrointestinal Endoscopy - Diagnostic | $3,199 | 50% | $1,599 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,909 | 50% | $2,955 |
Medium |
| Urine Test - Automated with Microscope Examination | $47 | 50% | $24 |
Medium |
| Urine Test - Automated without Microscope | $27 | 50% | $14 |
Medium |
| Urine Test - Bacterial Culture | $91 | 50% | $46 |
Medium |
| Urine Test - Chlamydia | $123 | 50% | $61 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $128 | 50% | $64 |
Medium |
| Urine Test - Pregnancy | $61 | 50% | $30 |
Medium |
| X-Ray - Abdomen | $327 | 50% | $163 |
Medium |
| X-Ray - Ankle (outpatient) | $502 | 50% | $251 |
Medium |
| X-Ray - Chest (outpatient) | $646 | 50% | $323 |
Medium |
| X-Ray - Foot (outpatient) | $509 | 50% | $255 |
Medium |
| X-Ray - Hand | $512 | 50% | $256 |
Medium |
| X-Ray - Hip | $355 | 50% | $177 |
Medium |
| X-Ray - Knee (outpatient) | $497 | 50% | $248 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $517 | 50% | $258 |
Medium |
| X-Ray - Neck, Cervical Spine | $1,053 | 50% | $527 |
Medium |
| X-Ray - Shoulder (outpatient) | $623 | 50% | $311 |
Medium |
| X-Ray - Spine (outpatient) | $579 | 50% | $289 |
Medium |
| X-Ray - Wrist (outpatient) | $399 | 50% | $200 |
Medium |
