| Arthrocentesis (outpatient) | $460 | 50% | $230 |
| Bacterial Culture - Aerobic Isolates | $54 | 50% | $27 |
| Bacterial Culture - Swab | $172 | 50% | $86 |
| Blood Test - Basic Metabolic Panel | $107 | 50% | $54 |
| Blood Test - Cholesterol Test, Lipid Panel | $108 | 50% | $54 |
| Blood Test - Clotting Time | $49 | 50% | $25 |
| Blood Test - Coagulation Assessment | $133 | 50% | $67 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $55 | 50% | $27 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 50% | $33 |
| Blood Test - Comprehensive Metabolic Panel | $90 | 50% | $45 |
| Blood Test - Ferritin (Blood Protein) Level | $155 | 50% | $78 |
| Blood Test - Folic Acid Level | $153 | 50% | $77 |
| Blood Test - General Health Panel | $303 | 50% | $152 |
| Blood Test - Hepatic (Liver) Function Panel | $92 | 50% | $46 |
| Blood Test - Lipase (fat enzyme) Level | $124 | 50% | $62 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $147 | 50% | $74 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $163 | 50% | $81 |
| Blood Test - Vitamin D-3 Level | $252 | 50% | $126 |
| Bone Density Scan (outpatient) | $528 | 50% | $264 |
| Colonoscopy - With Biopsy (outpatient) | $7,203 | 50% | $3,602 |
| Colonoscopy - With Polyp Removal (outpatient) | $7,543 | 50% | $3,771 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,381 | 50% | $2,691 |
| CT Scan - Chest, with Contrast (outpatient) | $2,334 | 50% | $1,167 |
| Emergency Department Visit - Low Complexity (outpatient) | $340 | 50% | $170 |
| Emergency Department Visit - Minor (outpatient) | $205 | 50% | $102 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $676 | 50% | $338 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $55 | 50% | $27 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $110 | 50% | $55 |
| Lab Test - Detection test for Influenza Virus | $50 | 50% | $25 |
| Lab Test - Smear for Microorganism | $48 | 50% | $24 |
| Mammogram (outpatient) | $837 | 50% | $418 |
| MRI - Back (outpatient) | $2,225 | 50% | $1,112 |
| MRI - Brain (outpatient) | $3,890 | 50% | $1,945 |
| MRI - Knee (outpatient) | $2,115 | 50% | $1,057 |
| MRI - Shoulder, Elbow, or Wrist | $2,115 | 50% | $1,057 |
| Myocardial Imaging (outpatient) | $7,266 | 50% | $3,633 |
| Office Visit - Basic | $118 | 50% | $59 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $306 | 50% | $153 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $359 | 50% | $180 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $359 | 50% | $180 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $402 | 50% | $201 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $318 | 50% | $159 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $294 | 50% | $147 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 50% | $141 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $306 | 50% | $153 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $312 | 50% | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $333 | 50% | $166 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $280 | 50% | $140 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $264 | 50% | $132 |
| Office Visit - Established Patient, High Complexity | $381 | 50% | $191 |
| Office Visit - Established Patient, Low Complexity | $194 | 50% | $97 |
| Office Visit - Established Patient, Moderate Complexity | $286 | 50% | $143 |
| Office Visit - New Patient, Low Complexity | $289 | 50% | $144 |
| Office Visit - New Patient, Minor | $200 | 50% | $100 |
| Office Visit - New Patient, Moderate Complexity | $373 | 50% | $186 |
| Physical Therapy - High Complexity Evaluation | $275 | 50% | $138 |
| Physical Therapy - Low Complexity Evaluation | $275 | 50% | $138 |
| Physical Therapy - Manual Therapy | $132 | 50% | $66 |
| Physical Therapy - Moderate Complexity Evaluation | $275 | 50% | $138 |
| Physical Therapy - Re-Evaluation | $154 | 50% | $77 |
| Physical Therapy - Therapeutic Activities | $132 | 50% | $66 |
| Physical Therapy - Therapeutic Exercises | $132 | 50% | $66 |
| Strep Test (Streptococcus, group A) | $42 | 50% | $21 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $69 | 50% | $35 |
| Ultrasound - Abdominal, Complete | $863 | 50% | $432 |
| Ultrasound - Abdominal, Limited | $432 | 50% | $216 |
| Ultrasound - Breast (outpatient) | $1,305 | 50% | $653 |
| Ultrasound - Head and Neck | $714 | 50% | $357 |
| Ultrasound - Pelvic (outpatient) | $1,173 | 50% | $586 |
| Urine Test - Automated with Microscope Examination | $152 | 50% | $76 |
| Urine Test - Bacterial Culture | $67 | 50% | $34 |
| Urine Test - Chlamydia | $236 | 50% | $118 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $236 | 50% | $118 |
| Urine Test - Pregnancy | $23 | 50% | $12 |
| Urine Test - Urinalysis, Manual Test | $9 | 50% | $5 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $95 | 50% | $47 |
| X-Ray - Abdomen | $409 | 50% | $204 |
| X-Ray - Ankle (outpatient) | $631 | 50% | $316 |
| X-Ray - Chest (outpatient) | $790 | 50% | $395 |
| X-Ray - Foot (outpatient) | $631 | 50% | $316 |
| X-Ray - Hand | $636 | 50% | $318 |
| X-Ray - Hip | $644 | 50% | $322 |
| X-Ray - Knee (outpatient) | $639 | 50% | $320 |
| X-Ray - Neck, Cervical Spine | $659 | 50% | $330 |
| X-Ray - Shoulder (outpatient) | $586 | 50% | $293 |
| X-Ray - Spine (outpatient) | $613 | 50% | $307 |
| X-Ray - Wrist (outpatient) | $554 | 50% | $277 |
