| Arthrocentesis (outpatient) | $314 | 38% | $195 |
| Bacterial Culture - Aerobic Isolates | $15 | 38% | $9 |
| Bacterial Culture - Swab | $17 | 38% | $10 |
| Biopsy - Breast | $6,277 | 38% | $3,892 |
| Biopsy - Endometrial (Uterus) | $785 | 38% | $487 |
| Biopsy - Punch Biopsy of Skin | $567 | 38% | $352 |
| Blood Test - Basic Metabolic Panel | $16 | 38% | $10 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $19 | 38% | $12 |
| Blood Test - Cholesterol Test, Lipid Panel | $26 | 38% | $16 |
| Blood Test - Clotting Time | $7 | 38% | $5 |
| Blood Test - Coagulation Assessment | $12 | 38% | $7 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $13 | 38% | $8 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $15 | 38% | $9 |
| Blood Test - Comprehensive Metabolic Panel | $20 | 38% | $12 |
| Blood Test - Electrolytes Panel | $14 | 38% | $8 |
| Blood Test - Ferritin (Blood Protein) Level | $26 | 38% | $16 |
| Blood Test - Folic Acid Level | $28 | 38% | $18 |
| Blood Test - General Health Panel | $67 | 38% | $42 |
| Blood Test - Hepatic (Liver) Function Panel | $16 | 38% | $10 |
| Blood Test - Hepatitis C Antibody Level | $25 | 38% | $16 |
| Blood Test - Iron Level | $13 | 38% | $8 |
| Blood Test - Lipase (fat enzyme) Level | $14 | 38% | $8 |
| Blood Test - Pregnancy (Obstetric) Panel | $191 | 38% | $118 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $28 | 38% | $18 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $33 | 38% | $20 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $17 | 38% | $10 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $32 | 38% | $20 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $23 | 38% | $14 |
| Blood Test - Vitamin D-3 Level | $56 | 38% | $35 |
| Bone Density Scan (outpatient) | $743 | 38% | $461 |
| Chiropractic Manipulative Treatment - Spinal, 1-2 Regions | $62 | 38% | $38 |
| Colonoscopy - Diagnostic (outpatient) | $7,988 | 38% | $4,953 |
| Colonoscopy - With Biopsy (outpatient) | $8,900 | 38% | $5,518 |
| Colonoscopy - With Polyp Removal (outpatient) | $9,789 | 38% | $6,069 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,059 | 38% | $1,277 |
| CT Scan - Chest, with Contrast (outpatient) | $2,459 | 38% | $1,525 |
| CT Scan - Head/Brain, without Contrast | $1,516 | 38% | $940 |
| Cystoscopy | $6,322 | 38% | $3,920 |
| Destruction of Lesion (outpatient) | $318 | 38% | $197 |
| Detection test for Human Papillomavirus (HPV) | $59 | 38% | $36 |
| Electrocardiogram (ECG or EKG) | $453 | 38% | $281 |
| Emergency Department Visit - Low Complexity (outpatient) | $716 | 38% | $444 |
| Emergency Department Visit - Minor (outpatient) | $426 | 38% | $264 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,838 | 38% | $1,139 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | 38% | $10 |
| Fetal Non-Stress Test | $1,174 | 38% | $728 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $19 | 38% | $12 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $42 | 38% | $26 |
| Lab Test - Detection test for Influenza Virus | $21 | 38% | $13 |
| Lab Test - Smear for Microorganism | $8 | 38% | $5 |
| Laryngoscopy - Diagnostic | $557 | 38% | $345 |
| Mammogram (outpatient) | $819 | 38% | $508 |
| MRI - Back (outpatient) | $2,844 | 38% | $1,764 |
| MRI - Brain (outpatient) | $4,477 | 38% | $2,776 |
| MRI - Knee (outpatient) | $2,856 | 38% | $1,771 |
| MRI - Pelvis (outpatient) | $4,476 | 38% | $2,775 |
| MRI - Shoulder, Elbow, or Wrist | $2,844 | 38% | $1,764 |
| Myocardial Imaging (outpatient) | $9,866 | 38% | $6,117 |
| Nasal Endoscopy - Diagnostic | $702 | 38% | $436 |
| Office Visit - Basic | $97 | 38% | $60 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $328 | 38% | $203 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $320 | 38% | $199 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $311 | 38% | $193 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $361 | 38% | $224 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $306 | 38% | $189 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $261 | 38% | $162 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $251 | 38% | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $274 | 38% | $170 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $279 | 38% | $173 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $298 | 38% | $185 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $250 | 38% | $155 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $234 | 38% | $145 |
| Office Visit - Established Patient, High Complexity | $317 | 38% | $197 |
| Office Visit - Established Patient, Low Complexity | $160 | 38% | $99 |
| Office Visit - Established Patient, Moderate Complexity | $235 | 38% | $146 |
| Office Visit - New Patient, Low Complexity | $236 | 38% | $146 |
| Office Visit - New Patient, Minor | $165 | 38% | $102 |
| Office Visit - New Patient, Moderate Complexity | $359 | 38% | $223 |
| Pap Test | $175 | 38% | $109 |
| Physical Therapy - Low Complexity Evaluation | $378 | 38% | $234 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $79 | 38% | $49 |
| Physical Therapy - Manual Therapy | $90 | 38% | $56 |
| Physical Therapy - Moderate Complexity Evaluation | $378 | 38% | $234 |
| Physical Therapy - Neuromuscular Reeducation | $90 | 38% | $56 |
| Physical Therapy - Re-Evaluation | $202 | 38% | $125 |
| Physical Therapy - Therapeutic Activities | $90 | 38% | $56 |
| Physical Therapy - Therapeutic Exercises | $90 | 38% | $56 |
| Physical Therapy - Ultrasound Therapy | $90 | 38% | $56 |
| Strep Test (Streptococcus, group A) | $22 | 38% | $14 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | 38% | $7 |
| Tonsillectomy with Adenoidectomy (outpatient) | $12,698 | 38% | $7,873 |
| Ultrasound - Abdominal, Complete | $775 | 38% | $480 |
| Ultrasound - Abdominal, Limited | $728 | 38% | $451 |
| Ultrasound - Breast (outpatient) | $771 | 38% | $478 |
| Ultrasound - Head and Neck | $720 | 38% | $447 |
| Ultrasound - Pregnancy (outpatient) | $814 | 38% | $505 |
| Ultrasound - Pregnancy Follow-Up | $515 | 38% | $319 |
| Ultrasound - Transvaginal (non-maternity) | $1,863 | 38% | $1,155 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $7,345 | 38% | $4,554 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $9,358 | 38% | $5,802 |
| Urine Capacity Measurement | $267 | 38% | $165 |
| Urine Test - Automated with Microscope Examination | $6 | 38% | $4 |
| Urine Test - Automated without Microscope | $3 | 38% | $2 |
| Urine Test - Bacterial Culture | $8 | 38% | $5 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $13 | 38% | $8 |
| Urine Test - Chlamydia | $48 | 38% | $30 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $49 | 38% | $31 |
| Urine Test - Microalbumin (Protein) Level | $11 | 38% | $7 |
| Urine Test - Pregnancy | $11 | 38% | $7 |
| Urine Test - Urinalysis, Manual Test | $4 | 38% | $3 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $397 | 38% | $246 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $64 | 38% | $40 |
| X-Ray - Abdomen | $370 | 38% | $229 |
| X-Ray - Ankle (outpatient) | $341 | 38% | $212 |
| X-Ray - Chest (outpatient) | $360 | 38% | $223 |
| X-Ray - Foot (outpatient) | $345 | 38% | $214 |
| X-Ray - Hand | $365 | 38% | $227 |
| X-Ray - Hip | $365 | 38% | $227 |
| X-Ray - Knee (outpatient) | $437 | 38% | $271 |
| X-Ray - Middle Back, Thoracic Spine | $376 | 38% | $233 |
| X-Ray - Neck, Cervical Spine | $448 | 38% | $278 |
| X-Ray - Pelvis | $376 | 38% | $233 |
| X-Ray - Shoulder (outpatient) | $419 | 38% | $260 |
| X-Ray - Spine (outpatient) | $485 | 38% | $301 |
| X-Ray - Wrist (outpatient) | $229 | 38% | $142 |
