| Arthrocentesis (outpatient) | $933 | 50% | $467 | 
Medium |
| Bacterial Culture Swab | $80 | 50% | $40 |
Medium |
| Blood Test - Basic Metabolic Panel | $71 | 50% | $36 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $85 | 50% | $43 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | 50% | $56 |
Medium |
| Blood Test - Clotting Time | $42 | 50% | $21 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $58 | 50% | $29 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $87 | 50% | $44 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $88 | 50% | $44 |
Medium |
| Blood Test - Electrolytes Panel | $59 | 50% | $29 |
Medium |
| Blood Test - Folic Acid Level | $123 | 50% | $61 |
Medium |
| Blood Test - General Health Panel | $316 | 50% | $158 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $68 | 50% | $34 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $123 | 50% | $61 |
Medium |
| Blood Test - LDL Cholesterol Level | $75 | 50% | $37 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $54 | 50% | $27 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $586 | 50% | $293 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $119 | 50% | $59 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $141 | 50% | $70 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $129 | 50% | $65 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $100 | 50% | $50 |
Medium |
| Blood Test - Vitamin D-3 Level | $247 | 50% | $123 |
Medium |
| Bone Density Scan (outpatient) | $518 | 50% | $259 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $7,694 | 50% | $3,847 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,667 | 50% | $1,833 |
Medium |
| Destruction of Lesion (outpatient) | $321 | 50% | $161 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $228 | 50% | $114 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $345 | 50% | $173 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $231 | 50% | $116 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $583 | 50% | $291 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $78 | 50% | $39 |
Medium |
| Mammogram (outpatient) | $1,182 | 50% | $591 |
Medium |
| MRI - Back (outpatient) | $3,741 | 50% | $1,871 |
Medium |
| MRI - Brain (outpatient) | $5,997 | 50% | $2,998 |
Medium |
| MRI - Knee (outpatient) | $3,528 | 50% | $1,764 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,568 | 50% | $1,284 |
Medium |
| Office Visit - Basic | $104 | 50% | $52 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $328 | 50% | $164 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $348 | 50% | $174 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $348 | 50% | $174 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $413 | 50% | $206 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $328 | 50% | $164 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $305 | 50% | $152 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $254 | 50% | $127 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $323 | 50% | $162 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $328 | 50% | $164 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $389 | 50% | $194 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $254 | 50% | $127 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $229 | 50% | $114 |
Medium |
| Office Visit - Established Patient, High Complexity | $306 | 50% | $153 |
Medium |
| Office Visit - Established Patient, Low Complexity | $148 | 50% | $74 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $233 | 50% | $117 |
Medium |
| Office Visit - New Patient, Low Complexity | $268 | 50% | $134 |
Medium |
| Office Visit - New Patient, Minor | $177 | 50% | $89 |
Medium |
| Pap Test | $175 | 50% | $88 |
Medium |
| Physical Therapy - High Complexity Evaluation | $368 | 50% | $184 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $289 | 50% | $144 |
Medium |
| Physical Therapy - Manual Therapy | $153 | 50% | $77 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $341 | 50% | $171 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $124 | 50% | $62 |
Medium |
| Physical Therapy - Therapeutic Activities | $130 | 50% | $65 |
Medium |
| Physical Therapy - Therapeutic Exercises | $138 | 50% | $69 |
Medium |
| Physical Therapy - Ultrasound Therapy | $84 | 50% | $42 |
Medium |
| Strep Test (Streptococcus, group A) | $100 | 50% | $50 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $55 | 50% | $27 |
Medium |
| Ultrasound - Abdominal, Complete | $916 | 50% | $458 |
Medium |
| Ultrasound - Abdominal, Limited | $964 | 50% | $482 |
Medium |
| Ultrasound - Breast (outpatient) | $1,634 | 50% | $817 | 
High |
| Ultrasound - Head and Neck | $854 | 50% | $427 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,741 | 50% | $870 |
Medium |
| Urine Test - Automated with Microscope Examination | $45 | 50% | $23 |
Medium |
| Urine Test - Automated without Microscope | $18 | 50% | $9 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $65 | 50% | $33 |
Medium |
| Urine Test - Chlamydia | $216 | 50% | $108 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $216 | 50% | $108 |
Medium |
| Urine Test - Pregnancy | $56 | 50% | $28 |
Medium |
| X-Ray - Abdomen | $507 | 50% | $254 |
Medium |
| X-Ray - Ankle (outpatient) | $499 | 50% | $249 |
Medium |
| X-Ray - Chest (outpatient) | $447 | 50% | $224 |
Medium |
| X-Ray - Foot (outpatient) | $523 | 50% | $262 |
Medium |
| X-Ray - Hand | $567 | 50% | $283 |
Medium |
| X-Ray - Hip | $580 | 50% | $290 |
Medium |
| X-Ray - Knee (outpatient) | $491 | 50% | $246 |
Medium |
| X-Ray - Neck, Cervical Spine | $393 | 50% | $196 |
Medium |
| X-Ray - Shoulder (outpatient) | $516 | 50% | $258 |
Medium |
| X-Ray - Spine (outpatient) | $492 | 50% | $246 |
Medium |
| X-Ray - Wrist (outpatient) | $593 | 50% | $296 |
High |
