| Arthrocentesis (outpatient) | $713 | 35% | $464 |
| Arthroscopic Knee Surgery (outpatient) | $16,941 | 35% | $11,012 |
| Bacterial Culture - Aerobic Isolates | $54 | 35% | $35 |
| Bacterial Culture - Swab | $172 | 35% | $112 |
| Biopsy - Punch Biopsy of Skin | $621 | 35% | $404 |
| Biopsy - Tangential Biopsy of Skin | $477 | 35% | $310 |
| Blood Test - Basic Metabolic Panel | $102 | 35% | $66 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $55 | 35% | $35 |
| Blood Test - Cholesterol Test, Lipid Panel | $152 | 35% | $99 |
| Blood Test - Clotting Time | $58 | 35% | $38 |
| Blood Test - Coagulation Assessment | $61 | 35% | $40 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $40 | 35% | $26 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $88 | 35% | $57 |
| Blood Test - Comprehensive Metabolic Panel | $145 | 35% | $94 |
| Blood Test - Ferritin (Blood Protein) Level | $107 | 35% | $70 |
| Blood Test - Folic Acid Level | $131 | 35% | $85 |
| Blood Test - General Health Panel | $427 | 35% | $278 |
| Blood Test - Hepatic (Liver) Function Panel | $142 | 35% | $92 |
| Blood Test - Hepatitis C Antibody Level | $195 | 35% | $127 |
| Blood Test - Lipase (fat enzyme) Level | $66 | 35% | $43 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $152 | 35% | $99 |
| Blood Test - Renal (Kidney) Function Panel | $89 | 35% | $58 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $194 | 35% | $126 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $131 | 35% | $85 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $237 | 35% | $154 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | 35% | $63 |
| Blood Test - Vitamin D-3 Level | $227 | 35% | $147 |
| Bone Density Scan (outpatient) | $671 | 35% | $436 |
| Colonoscopy - Diagnostic (outpatient) | $6,074 | 35% | $3,948 |
| Colonoscopy - With Biopsy (outpatient) | $6,511 | 35% | $4,232 |
| Colonoscopy - With Polyp Removal (outpatient) | $7,645 | 35% | $4,969 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,207 | 35% | $3,385 |
| CT Scan - Chest, with Contrast (outpatient) | $2,729 | 35% | $1,774 |
| Destruction of Lesion (outpatient) | $215 | 35% | $140 |
| Detection test for Human Papillomavirus (HPV) | $316 | 35% | $205 |
| Electrocardiogram (ECG or EKG) | $559 | 35% | $363 |
| Emergency Department Visit - Low Complexity (outpatient) | $413 | 35% | $268 |
| Emergency Department Visit - Minor (outpatient) | $225 | 35% | $146 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $606 | 35% | $394 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $55 | 35% | $35 |
| Fetal Non-Stress Test | $674 | 35% | $438 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $117 | 35% | $76 |
| Lab Test - Smear for Microorganism | $48 | 35% | $31 |
| Mammogram (outpatient) | $794 | 35% | $516 |
| MRI - Back (outpatient) | $3,558 | 35% | $2,313 |
| MRI - Brain (outpatient) | $6,792 | 35% | $4,415 |
| MRI - Knee (outpatient) | $3,154 | 35% | $2,050 |
| MRI - Shoulder, Elbow, or Wrist | $3,125 | 35% | $2,031 |
| Myocardial Imaging (outpatient) | $6,887 | 35% | $4,477 |
| Office Visit - Basic | $87 | 35% | $57 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $210 | 35% | $137 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $234 | 35% | $152 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $227 | 35% | $147 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $264 | 35% | $171 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $208 | 35% | $135 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $195 | 35% | $127 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $184 | 35% | $119 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $200 | 35% | $130 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $204 | 35% | $132 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $217 | 35% | $141 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $182 | 35% | $118 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $171 | 35% | $111 |
| Office Visit - Established Patient, High Complexity | $259 | 35% | $169 |
| Office Visit - Established Patient, Low Complexity | $135 | 35% | $88 |
| Office Visit - Established Patient, Moderate Complexity | $198 | 35% | $129 |
| Office Visit - New Patient, Low Complexity | $186 | 35% | $121 |
| Office Visit - New Patient, Minor | $129 | 35% | $84 |
| Office Visit - New Patient, Moderate Complexity | $284 | 35% | $184 |
| Pap Test | $127 | 35% | $83 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $88 | 35% | $57 |
| Physical Therapy - High Complexity Evaluation | $368 | 35% | $239 |
| Physical Therapy - Low Complexity Evaluation | $351 | 35% | $228 |
| Physical Therapy - Moderate Complexity Evaluation | $357 | 35% | $232 |
| Physical Therapy - Self-care or Home Management Training | $133 | 35% | $87 |
| Physical Therapy - Therapeutic Activities | $137 | 35% | $89 |
| Physical Therapy - Therapeutic Exercises | $147 | 35% | $96 |
| Physical Therapy - Ultrasound Therapy | $81 | 35% | $53 |
| Psychiatric Diagnostic Evaluation | $269 | 35% | $175 |
| Psychotherapy - 30 Minutes | $112 | 35% | $73 |
| Psychotherapy - 45 Minutes | $150 | 35% | $98 |
| Psychotherapy - Family Session | $190 | 35% | $124 |
| Strep Test (Streptococcus, group A) | $51 | 35% | $33 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $35 | 35% | $23 |
| Ultrasound - Abdominal, Complete | $1,373 | 35% | $893 |
| Ultrasound - Abdominal, Limited | $772 | 35% | $502 |
| Ultrasound - Breast (outpatient) | $1,190 | 35% | $773 |
| Ultrasound - Head and Neck | $1,006 | 35% | $654 |
| Ultrasound - Pelvic (outpatient) | $1,003 | 35% | $652 |
| Ultrasound - Pregnancy Follow-Up | $756 | 35% | $491 |
| Urine Test - Automated with Microscope Examination | $45 | 35% | $29 |
| Urine Test - Automated without Microscope | $30 | 35% | $20 |
| Urine Test - Chlamydia | $170 | 35% | $111 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $170 | 35% | $111 |
| Urine Test - Pregnancy | $29 | 35% | $19 |
| Urine Test - Urinalysis, Manual Test | $20 | 35% | $13 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $317 | 35% | $206 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $79 | 35% | $51 |
| X-Ray - Abdomen | $712 | 35% | $463 |
| X-Ray - Ankle (outpatient) | $511 | 35% | $332 |
| X-Ray - Chest (outpatient) | $796 | 35% | $517 |
| X-Ray - Foot (outpatient) | $704 | 35% | $457 |
| X-Ray - Hand | $690 | 35% | $448 |
| X-Ray - Hip | $856 | 35% | $557 |
| X-Ray - Knee (outpatient) | $742 | 35% | $482 |
| X-Ray - Middle Back, Thoracic Spine | $740 | 35% | $481 |
| X-Ray - Pelvis | $978 | 35% | $635 |
| X-Ray - Shoulder (outpatient) | $910 | 35% | $592 |
| X-Ray - Spine (outpatient) | $566 | 35% | $368 |
| X-Ray - Wrist (outpatient) | $566 | 35% | $368 |
