| Arthrocentesis (outpatient) | $824 | 35% | $536 | 
High |
| Arthroscopic Knee Surgery (outpatient) | $17,208 | 35% | $11,185 |
High |
| Bacterial Culture Swab | $172 | 35% | $112 | 
Medium |
| Biopsy - Skin Lesion | $530 | 35% | $344 |
Medium |
| Blood Test - Basic Metabolic Panel | $102 | 35% | $66 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $55 | 35% | $35 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $152 | 35% | $99 |
Medium |
| Blood Test - Clotting Time | $58 | 35% | $38 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $40 | 35% | $26 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $88 | 35% | $57 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $145 | 35% | $94 |
Medium |
| Blood Test - Folic Acid Level | $131 | 35% | $85 |
Medium |
| Blood Test - General Health Panel | $194 | 35% | $126 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $142 | 35% | $92 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $195 | 35% | $127 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $66 | 35% | $43 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $152 | 35% | $99 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $89 | 35% | $58 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $194 | 35% | $126 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $131 | 35% | $85 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 35% | $63 |
Medium |
| Blood Test - Vitamin D-3 Level | $227 | 35% | $147 |
Medium |
| Bone Density Scan (outpatient) | $671 | 35% | $436 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $6,055 | 35% | $3,936 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $6,540 | 35% | $4,251 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $7,395 | 35% | $4,807 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,968 | 35% | $3,229 |
High |
| CT Scan - Chest, with Contrast (outpatient) | $2,718 | 35% | $1,767 |
Medium |
| Destruction of Lesion (outpatient) | $219 | 35% | $142 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $316 | 35% | $205 |
Medium |
| Electrocardiogram (ECG or EKG) | $662 | 35% | $430 |
High |
| Emergency Department Visit - Low Complexity (outpatient) | $401 | 35% | $261 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $225 | 35% | $146 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $588 | 35% | $382 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $50 | 35% | $33 |
Medium |
| Fetal Non-Stress Test | $781 | 35% | $508 |
Medium |
| Mammogram (outpatient) | $751 | 35% | $488 |
Medium |
| MRI - Back (outpatient) | $3,558 | 35% | $2,313 |
Medium |
| MRI - Brain (outpatient) | $6,771 | 35% | $4,401 |
Medium |
| MRI - Knee (outpatient) | $3,154 | 35% | $2,050 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $3,125 | 35% | $2,031 |
Medium |
| Myocardial Imaging (outpatient) | $6,887 | 35% | $4,477 |
Medium |
| Office Visit - Basic | $87 | 35% | $57 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $210 | 35% | $137 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $225 | 35% | $146 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $253 | 35% | $164 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $208 | 35% | $135 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $195 | 35% | $127 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $184 | 35% | $119 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $198 | 35% | $129 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $198 | 35% | $129 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $213 | 35% | $139 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $182 | 35% | $118 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $169 | 35% | $110 |
Medium |
| Office Visit - Established Patient, High Complexity | $259 | 35% | $169 |
Medium |
| Office Visit - Established Patient, Low Complexity | $135 | 35% | $88 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $198 | 35% | $129 |
Medium |
| Office Visit - New Patient, Low Complexity | $156 | 35% | $102 |
Medium |
| Office Visit - New Patient, Minor | $105 | 35% | $68 |
Medium |
| Pap Test | $127 | 35% | $83 |
Medium |
| Physical Therapy - High Complexity Evaluation | $368 | 35% | $239 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $351 | 35% | $228 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $357 | 35% | $232 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $133 | 35% | $87 |
Medium |
| Physical Therapy - Therapeutic Activities | $137 | 35% | $89 |
Medium |
| Physical Therapy - Therapeutic Exercises | $147 | 35% | $96 |
Medium |
| Physical Therapy - Ultrasound Therapy | $81 | 35% | $53 |
Medium |
| Psychiatric Diagnostic Evaluation | $269 | 35% | $175 |
Medium |
| Psychotherapy - 30 Minutes | $112 | 35% | $73 |
Medium |
| Psychotherapy - 45 Minutes | $144 | 35% | $94 |
Medium |
| Psychotherapy - 60 Minutes | $211 | 35% | $137 |
Medium |
| Psychotherapy - Family Session | $190 | 35% | $124 |
Medium |
| Strep Test (Streptococcus, group A) | $51 | 35% | $33 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $35 | 35% | $23 |
Medium |
| Ultrasound - Abdominal, Complete | $1,373 | 35% | $893 |
Medium |
| Ultrasound - Abdominal, Limited | $721 | 35% | $469 |
Medium |
| Ultrasound - Breast (outpatient) | $1,126 | 35% | $732 |
Medium |
| Ultrasound - Head and Neck | $1,006 | 35% | $654 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,003 | 35% | $652 |
Medium |
| Urine Test - Automated with Microscope Examination | $45 | 35% | $29 |
Medium |
| Urine Test - Automated without Microscope | $30 | 35% | $20 |
Medium |
| Urine Test - Chlamydia | $158 | 35% | $102 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $158 | 35% | $102 |
Medium |
| Urine Test - Pregnancy | $29 | 35% | $19 |
Medium |
| X-Ray - Abdomen | $712 | 35% | $463 |
Medium |
| X-Ray - Ankle (outpatient) | $502 | 35% | $326 |
Medium |
| X-Ray - Chest (outpatient) | $753 | 35% | $489 |
Medium |
| X-Ray - Foot (outpatient) | $643 | 35% | $418 |
Medium |
| X-Ray - Hand | $643 | 35% | $418 |
Medium |
| X-Ray - Hip | $795 | 35% | $517 |
Medium |
| X-Ray - Knee (outpatient) | $709 | 35% | $461 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $730 | 35% | $475 |
Medium |
| X-Ray - Pelvis | $917 | 35% | $596 |
Medium |
| X-Ray - Shoulder (outpatient) | $885 | 35% | $575 |
Medium |
| X-Ray - Spine (outpatient) | $555 | 35% | $361 |
Medium |
| X-Ray - Wrist (outpatient) | $519 | 35% | $337 |
Medium |
