| Arthrocentesis (outpatient) | $458 | 50% | $229 | 
Medium |
| Arthroscopic Knee Surgery (outpatient) | $13,336 | 50% | $6,668 |
Medium |
| Blood Test - Basic Metabolic Panel | $100 | 50% | $50 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $122 | 50% | $61 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $101 | 50% | $50 |
Medium |
| Blood Test - Clotting Time | $49 | 50% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $50 | 50% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $61 | 50% | $30 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $84 | 50% | $42 |
Medium |
| Blood Test - Electrolytes Panel | $28 | 50% | $14 |
Medium |
| Blood Test - General Health Panel | $281 | 50% | $141 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $86 | 50% | $43 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $137 | 50% | $68 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $151 | 50% | $76 |
Medium |
| Blood Test - Vitamin D-3 Level | $392 | 50% | $196 |
Medium |
| Bone Density Scan (outpatient) | $505 | 50% | $253 | 
High |
| Colonoscopy - Diagnostic (outpatient) | $5,263 | 50% | $2,631 |
High |
| Colonoscopy - With Biopsy (outpatient) | $6,803 | 50% | $3,401 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $7,449 | 50% | $3,724 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,102 | 50% | $2,551 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,222 | 50% | $1,111 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $105 | 50% | $53 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $194 | 50% | $97 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $676 | 50% | $338 |
Medium |
| Mammogram (outpatient) | $800 | 50% | $400 |
Medium |
| MRI - Back (outpatient) | $2,875 | 50% | $1,437 |
Medium |
| MRI - Brain (outpatient) | $4,928 | 50% | $2,464 |
Medium |
| MRI - Knee (outpatient) | $2,736 | 50% | $1,368 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,736 | 50% | $1,368 |
Medium |
| Myocardial Imaging (outpatient) | $6,257 | 50% | $3,129 |
High |
| Office Visit - Basic | $118 | 50% | $59 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $306 | 50% | $153 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $359 | 50% | $180 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $359 | 50% | $180 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $402 | 50% | $201 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $318 | 50% | $159 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $294 | 50% | $147 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 50% | $141 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $306 | 50% | $153 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $312 | 50% | $156 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $333 | 50% | $166 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $280 | 50% | $140 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $264 | 50% | $132 |
Medium |
| Office Visit - Established Patient, High Complexity | $381 | 50% | $191 |
Medium |
| Office Visit - Established Patient, Low Complexity | $194 | 50% | $97 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $286 | 50% | $143 |
Medium |
| Office Visit - New Patient, Low Complexity | $289 | 50% | $144 |
Medium |
| Office Visit - New Patient, Minor | $200 | 50% | $100 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $261 | 50% | $131 |
Medium |
| Physical Therapy - Manual Therapy | $126 | 50% | $63 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $261 | 50% | $131 |
Medium |
| Physical Therapy - Therapeutic Activities | $126 | 50% | $63 |
Medium |
| Physical Therapy - Therapeutic Exercises | $126 | 50% | $63 |
Medium |
| Strep Test (Streptococcus, group A) | $42 | 50% | $21 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $64 | 50% | $32 |
Medium |
| Ultrasound - Abdominal, Complete | $828 | 50% | $414 |
Medium |
| Ultrasound - Abdominal, Limited | $416 | 50% | $208 |
High |
| Ultrasound - Breast (outpatient) | $1,202 | 50% | $601 |
Medium |
| Ultrasound - Head and Neck | $685 | 50% | $342 |
Medium |
| Urine Test - Automated with Microscope Examination | $142 | 50% | $71 |
Medium |
| Urine Test - Automated without Microscope | $37 | 50% | $18 |
Medium |
| Urine Test - Chlamydia | $221 | 50% | $110 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $221 | 50% | $110 |
Medium |
| Urine Test - Pregnancy | $23 | 50% | $12 |
Medium |
| X-Ray - Abdomen | $984 | 50% | $492 |
High |
| X-Ray - Ankle (outpatient) | $554 | 50% | $277 |
Medium |
| X-Ray - Chest (outpatient) | $759 | 50% | $379 |
Medium |
| X-Ray - Foot (outpatient) | $611 | 50% | $306 |
Medium |
| X-Ray - Hand | $614 | 50% | $307 |
Medium |
| X-Ray - Hip | $718 | 50% | $359 |
Medium |
| X-Ray - Knee (outpatient) | $620 | 50% | $310 |
Medium |
| X-Ray - Neck, Cervical Spine | $634 | 50% | $317 |
High |
| X-Ray - Pelvis | $964 | 50% | $482 |
Medium |
| X-Ray - Shoulder (outpatient) | $655 | 50% | $328 |
High |
| X-Ray - Spine (outpatient) | $545 | 50% | $272 |
Medium |
| X-Ray - Wrist (outpatient) | $611 | 50% | $306 |
Medium |
