| Arthrocentesis (outpatient) | $641 | 42% | $371 |
| Bacterial Culture - Aerobic Isolates | $119 | 42% | $69 |
| Bacterial Culture - Swab | $130 | 42% | $76 |
| Biopsy - Punch Biopsy of Skin | $1,110 | 42% | $644 |
| Biopsy - Tangential Biopsy of Skin | $1,519 | 42% | $881 |
| Blood Test - Basic Metabolic Panel | $66 | 42% | $38 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 42% | $52 |
| Blood Test - Cholesterol Test, Lipid Panel | $118 | 42% | $68 |
| Blood Test - Clotting Time | $53 | 42% | $30 |
| Blood Test - Coagulation Assessment | $62 | 42% | $36 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $62 | 42% | $36 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 42% | $38 |
| Blood Test - Comprehensive Metabolic Panel | $88 | 42% | $51 |
| Blood Test - Electrolytes Panel | $53 | 42% | $30 |
| Blood Test - Ferritin (Blood Protein) Level | $139 | 42% | $80 |
| Blood Test - Folic Acid Level | $126 | 42% | $73 |
| Blood Test - General Health Panel | $306 | 42% | $177 |
| Blood Test - Hepatic (Liver) Function Panel | $60 | 42% | $35 |
| Blood Test - Hepatitis C Antibody Level | $143 | 42% | $83 |
| Blood Test - Iron Level | $66 | 42% | $38 |
| Blood Test - Lipase (fat enzyme) Level | $64 | 42% | $37 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $131 | 42% | $76 |
| Blood Test - Renal (Kidney) Function Panel | $62 | 42% | $36 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 42% | $88 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $131 | 42% | $76 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $247 | 42% | $143 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $130 | 42% | $76 |
| Blood Test - Vitamin D-3 Level | $306 | 42% | $177 |
| Bone Density Scan (outpatient) | $517 | 42% | $300 |
| Colonoscopy - Diagnostic (outpatient) | $3,395 | 42% | $1,969 |
| Colonoscopy - With Biopsy (outpatient) | $4,768 | 42% | $2,765 |
| Colonoscopy - With Polyp Removal (outpatient) | $4,625 | 42% | $2,683 |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,454 | 42% | $2,583 |
| CT Scan - Chest, with Contrast (outpatient) | $2,622 | 42% | $1,521 |
| Destruction of Lesion (outpatient) | $628 | 42% | $364 |
| Destruction of Lesions, up to 14 | $421 | 42% | $244 |
| Detection test for Human Papillomavirus (HPV) | $278 | 42% | $161 |
| Emergency Department Visit - Low Complexity (outpatient) | $347 | 42% | $201 |
| Emergency Department Visit - Minor (outpatient) | $250 | 42% | $145 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $503 | 42% | $292 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $104 | 42% | $60 |
| Fetal Non-Stress Test | $457 | 42% | $265 |
| Gall Bladder Surgery (outpatient) | $20,339 | 42% | $11,797 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $106 | 42% | $62 |
| Lab Test - Detection test for Influenza Virus | $32 | 42% | $18 |
| Lab Test - Smear for Microorganism | $62 | 42% | $36 |
| Laryngoscopy - Diagnostic | $488 | 42% | $283 |
| Mammogram (outpatient) | $942 | 42% | $546 |
| MRI - Back (outpatient) | $3,373 | 42% | $1,956 |
| MRI - Brain (outpatient) | $5,688 | 42% | $3,299 |
| MRI - Knee (outpatient) | $3,520 | 42% | $2,041 |
| MRI - Shoulder, Elbow, or Wrist | $3,413 | 42% | $1,979 |
| Myocardial Imaging (outpatient) | $5,361 | 42% | $3,109 |
| Office Visit - Basic | $76 | 42% | $44 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | 42% | $152 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $282 | 42% | $164 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $282 | 42% | $164 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $289 | 42% | $167 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $261 | 42% | $152 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $238 | 42% | $138 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $225 | 42% | $130 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $245 | 42% | $142 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $246 | 42% | $143 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $269 | 42% | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $226 | 42% | $131 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $206 | 42% | $119 |
| Office Visit - Established Patient, High Complexity | $342 | 42% | $199 |
| Office Visit - Established Patient, Low Complexity | $169 | 42% | $98 |
| Office Visit - Established Patient, Moderate Complexity | $216 | 42% | $125 |
| Office Visit - New Patient, Low Complexity | $209 | 42% | $121 |
| Office Visit - New Patient, Minor | $133 | 42% | $77 |
| Office Visit - New Patient, Moderate Complexity | $305 | 42% | $177 |
| Pap Test | $126 | 42% | $73 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $154 | 42% | $90 |
| Physical Therapy - High Complexity Evaluation | $467 | 42% | $271 |
| Physical Therapy - Low Complexity Evaluation | $312 | 42% | $181 |
| Physical Therapy - Manual Therapy | $149 | 42% | $86 |
| Physical Therapy - Moderate Complexity Evaluation | $390 | 42% | $226 |
| Physical Therapy - Neuromuscular Reeducation | $102 | 42% | $59 |
| Physical Therapy - Self-care or Home Management Training | $106 | 42% | $62 |
| Physical Therapy - Therapeutic Activities | $134 | 42% | $78 |
| Physical Therapy - Therapeutic Exercises | $161 | 42% | $93 |
| Physical Therapy - Ultrasound Therapy | $75 | 42% | $43 |
| Strep Test (Streptococcus, group A) | $42 | 42% | $24 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $88 | 42% | $51 |
| Ultrasound - Abdominal, Complete | $1,093 | 42% | $634 |
| Ultrasound - Abdominal, Limited | $680 | 42% | $395 |
| Ultrasound - Breast (outpatient) | $1,470 | 42% | $853 |
| Ultrasound - Head and Neck | $880 | 42% | $510 |
| Ultrasound - Pelvic (outpatient) | $919 | 42% | $533 |
| Ultrasound - Pregnancy (outpatient) | $1,065 | 42% | $618 |
| Ultrasound - Pregnancy Follow-Up | $697 | 42% | $404 |
| Ultrasound - Transvaginal (non-maternity) | $930 | 42% | $540 |
| Urine Capacity Measurement | $371 | 42% | $215 |
| Urine Test - Automated with Microscope Examination | $47 | 42% | $27 |
| Urine Test - Automated without Microscope | $37 | 42% | $21 |
| Urine Test - Bacterial Culture | $63 | 42% | $37 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $69 | 42% | $40 |
| Urine Test - Chlamydia | $247 | 42% | $143 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $247 | 42% | $143 |
| Urine Test - Microalbumin (Protein) Level | $86 | 42% | $50 |
| Urine Test - Pregnancy | $22 | 42% | $13 |
| Urine Test - Urinalysis, Manual Test | $11 | 42% | $6 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $84 | 42% | $49 |
| X-Ray - Abdomen | $515 | 42% | $298 |
| X-Ray - Ankle (outpatient) | $518 | 42% | $300 |
| X-Ray - Chest (outpatient) | $490 | 42% | $284 |
| X-Ray - Foot (outpatient) | $377 | 42% | $219 |
| X-Ray - Hand | $523 | 42% | $304 |
| X-Ray - Hip | $336 | 42% | $195 |
| X-Ray - Knee (outpatient) | $469 | 42% | $272 |
| X-Ray - Middle Back, Thoracic Spine | $561 | 42% | $325 |
| X-Ray - Shoulder (outpatient) | $515 | 42% | $298 |
| X-Ray - Spine (outpatient) | $628 | 42% | $364 |
| X-Ray - Wrist (outpatient) | $421 | 42% | $244 |
