| Arthrocentesis (outpatient) | $498 | 33% | $333 |
| Bacterial Culture - Aerobic Isolates | $82 | 33% | $55 |
| Bacterial Culture - Swab | $58 | 33% | $39 |
| Biopsy - Punch Biopsy of Skin | $1,339 | 33% | $897 |
| Blood Test - Basic Metabolic Panel | $85 | 33% | $57 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $99 | 33% | $66 |
| Blood Test - Cholesterol Test, Lipid Panel | $137 | 33% | $91 |
| Blood Test - Clotting Time | $43 | 33% | $29 |
| Blood Test - Coagulation Assessment | $61 | 33% | $41 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $65 | 33% | $44 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $77 | 33% | $51 |
| Blood Test - Comprehensive Metabolic Panel | $108 | 33% | $72 |
| Blood Test - Electrolytes Panel | $71 | 33% | $48 |
| Blood Test - Ferritin (Blood Protein) Level | $138 | 33% | $92 |
| Blood Test - Folic Acid Level | $149 | 33% | $100 |
| Blood Test - General Health Panel | $354 | 33% | $237 |
| Blood Test - Hepatic (Liver) Function Panel | $83 | 33% | $56 |
| Blood Test - Hepatitis C Antibody Level | $134 | 33% | $90 |
| Blood Test - Iron Level | $65 | 33% | $44 |
| Blood Test - LDL Cholesterol Level | $93 | 33% | $63 |
| Blood Test - Lipase (fat enzyme) Level | $70 | 33% | $47 |
| Blood Test - Pregnancy (Obstetric) Panel | $516 | 33% | $345 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $147 | 33% | $98 |
| Blood Test - Renal (Kidney) Function Panel | $88 | 33% | $59 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $169 | 33% | $113 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $92 | 33% | $62 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $170 | 33% | $114 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $122 | 33% | $82 |
| Blood Test - Vitamin D-3 Level | $237 | 33% | $159 |
| Bone Density Scan (outpatient) | $875 | 33% | $586 |
| Colonoscopy - Diagnostic (outpatient) | $4,285 | 33% | $2,871 |
| Colonoscopy - With Biopsy (outpatient) | $5,516 | 33% | $3,696 |
| Colonoscopy - With Polyp Removal (outpatient) | $7,083 | 33% | $4,745 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,218 | 33% | $1,486 |
| CT Scan - Chest, with Contrast (outpatient) | $2,673 | 33% | $1,791 |
| Destruction of Lesion (outpatient) | $476 | 33% | $319 |
| Detection test for Human Papillomavirus (HPV) | $228 | 33% | $153 |
| Electrocardiogram (ECG or EKG) | $331 | 33% | $222 |
| Emergency Department Visit - Low Complexity (outpatient) | $210 | 33% | $141 |
| Emergency Department Visit - Minor (outpatient) | $124 | 33% | $83 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $420 | 33% | $281 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $88 | 33% | $59 |
| Fetal Non-Stress Test | $422 | 33% | $283 |
| Gall Bladder Surgery (outpatient) | $14,008 | 33% | $9,386 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $106 | 33% | $71 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $194 | 33% | $130 |
| Lab Test - Detection test for Influenza Virus | $41 | 33% | $27 |
| Lab Test - Smear for Microorganism | $43 | 33% | $29 |
| Mammogram (outpatient) | $1,259 | 33% | $843 |
| MRI - Back (outpatient) | $3,739 | 33% | $2,505 |
| MRI - Brain (outpatient) | $7,573 | 33% | $5,074 |
| MRI - Knee (outpatient) | $3,248 | 33% | $2,176 |
| MRI - Pelvis (outpatient) | $7,625 | 33% | $5,109 |
| MRI - Shoulder, Elbow, or Wrist | $3,235 | 33% | $2,167 |
| Myocardial Imaging (outpatient) | $4,726 | 33% | $3,166 |
| Office Visit - Basic | $97 | 33% | $65 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $268 | 33% | $180 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $284 | 33% | $190 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $327 | 33% | $219 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $268 | 33% | $179 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $237 | 33% | $159 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $258 | 33% | $173 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $264 | 33% | $177 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $281 | 33% | $189 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $236 | 33% | $158 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $222 | 33% | $148 |
| Office Visit - Established Patient, High Complexity | $356 | 33% | $238 |
| Office Visit - Established Patient, Low Complexity | $140 | 33% | $94 |
| Office Visit - Established Patient, Moderate Complexity | $205 | 33% | $137 |
| Office Visit - New Patient, Low Complexity | $210 | 33% | $141 |
| Office Visit - New Patient, Minor | $165 | 33% | $111 |
| Office Visit - New Patient, Moderate Complexity | $338 | 33% | $227 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $43 | 33% | $29 |
| Physical Therapy - Application of Mechanical Traction | $43 | 33% | $29 |
| Physical Therapy - Electrical Stimulation Therapy | $42 | 33% | $28 |
| Physical Therapy - High Complexity Evaluation | $257 | 33% | $172 |
| Physical Therapy - Low Complexity Evaluation | $257 | 33% | $172 |
| Physical Therapy - Manual Therapy | $78 | 33% | $52 |
| Physical Therapy - Moderate Complexity Evaluation | $257 | 33% | $172 |
| Physical Therapy - Neuromuscular Reeducation | $85 | 33% | $57 |
| Physical Therapy - Re-Evaluation | $116 | 33% | $77 |
| Physical Therapy - Self-care or Home Management Training | $88 | 33% | $59 |
| Physical Therapy - Therapeutic Activities | $87 | 33% | $58 |
| Physical Therapy - Therapeutic Exercises | $82 | 33% | $55 |
| Physical Therapy - Ultrasound Therapy | $36 | 33% | $24 |
| Strep Test (Streptococcus, group A) | $42 | 33% | $28 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $58 | 33% | $39 |
| Ultrasound - Abdominal, Complete | $1,070 | 33% | $717 |
| Ultrasound - Abdominal, Limited | $723 | 33% | $484 |
| Ultrasound - Breast (outpatient) | $1,621 | 33% | $1,086 |
| Ultrasound - Head and Neck | $723 | 33% | $485 |
| Ultrasound - Pelvic (outpatient) | $760 | 33% | $509 |
| Ultrasound - Transvaginal (non-maternity) | $906 | 33% | $607 |
| Urine Capacity Measurement | $213 | 33% | $143 |
| Urine Test - Automated with Microscope Examination | $34 | 33% | $23 |
| Urine Test - Automated without Microscope | $19 | 33% | $13 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $65 | 33% | $44 |
| Urine Test - Chlamydia | $264 | 33% | $177 |
| Urine Test - Microalbumin (Protein) Level | $55 | 33% | $37 |
| Urine Test - Pregnancy | $28 | 33% | $19 |
| Urine Test - Urinalysis, Manual Test | $21 | 33% | $14 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $298 | 33% | $200 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $58 | 33% | $39 |
| X-Ray - Abdomen | $249 | 33% | $167 |
| X-Ray - Ankle (outpatient) | $391 | 33% | $262 |
| X-Ray - Chest (outpatient) | $494 | 33% | $331 |
| X-Ray - Foot (outpatient) | $484 | 33% | $324 |
| X-Ray - Hand | $362 | 33% | $243 |
| X-Ray - Hip | $426 | 33% | $285 |
| X-Ray - Knee (outpatient) | $480 | 33% | $321 |
| X-Ray - Middle Back, Thoracic Spine | $418 | 33% | $280 |
| X-Ray - Neck, Cervical Spine | $477 | 33% | $320 |
| X-Ray - Shoulder (outpatient) | $445 | 33% | $298 |
| X-Ray - Spine (outpatient) | $359 | 33% | $241 |
| X-Ray - Wrist (outpatient) | $370 | 33% | $248 |
