| Arthrocentesis (outpatient) | $601 | 50% | $301 | 
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 | $65 | 50% | $33 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $88 | 50% | $44 |
Medium |
| Blood Test - Electrolytes Panel | $59 | 50% | $29 |
Medium |
| Blood Test - General Health Panel | $294 | 50% | $147 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $68 | 50% | $34 |
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) | $377 | 50% | $188 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $6,034 | 50% | $3,017 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $9,258 | 50% | $4,629 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,667 | 50% | $1,833 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $404 | 50% | $202 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $231 | 50% | $116 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $596 | 50% | $298 |
Medium |
| Mammogram (outpatient) | $1,156 | 50% | $578 |
Medium |
| MRI - Back (outpatient) | $3,099 | 50% | $1,549 |
Medium |
| MRI - Brain (outpatient) | $5,246 | 50% | $2,623 |
Medium |
| MRI - Knee (outpatient) | $3,528 | 50% | $1,764 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $2,653 | 50% | $1,327 |
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, 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 | $413 | 50% | $206 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $236 | 50% | $118 |
Medium |
| Physical Therapy - Manual Therapy | $129 | 50% | $65 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $291 | 50% | $145 |
Medium |
| Physical Therapy - Therapeutic Activities | $138 | 50% | $69 |
Medium |
| Physical Therapy - Therapeutic Exercises | $135 | 50% | $68 |
Medium |
| Physical Therapy - Ultrasound Therapy | $83 | 50% | $41 |
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 | $1,061 | 50% | $530 |
Medium |
| Ultrasound - Abdominal, Limited | $827 | 50% | $414 |
Medium |
| Ultrasound - Breast (outpatient) | $1,634 | 50% | $817 |
Medium |
| Ultrasound - Head and Neck | $854 | 50% | $427 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,448 | 50% | $724 |
Medium |
| Urine Test - Automated with Microscope Examination | $32 | 50% | $16 |
Medium |
| Urine Test - Automated without Microscope | $18 | 50% | $9 |
Medium |
| Urine Test - Bacterial Culture | $57 | 50% | $28 |
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 | 
High |
| X-Ray - Chest (outpatient) | $569 | 50% | $285 |
Medium |
| X-Ray - Foot (outpatient) | $572 | 50% | $286 |
Medium |
| X-Ray - Hand | $474 | 50% | $237 |
Medium |
| X-Ray - Hip | $582 | 50% | $291 |
Medium |
| X-Ray - Knee (outpatient) | $503 | 50% | $251 |
Medium |
| X-Ray - Neck, Cervical Spine | $403 | 50% | $202 |
Medium |
| X-Ray - Shoulder (outpatient) | $550 | 50% | $275 |
Medium |
| X-Ray - Spine (outpatient) | $491 | 50% | $246 |
Medium |
| X-Ray - Wrist (outpatient) | $509 | 50% | $255 |
Medium |
