| Arthrocentesis (outpatient) | $408 | 39% | $249 |
| Bacterial Culture - Aerobic Isolates | $88 | 39% | $54 |
| Bacterial Culture - Swab | $99 | 39% | $60 |
| Blood Test - Basic Metabolic Panel | $103 | 39% | $63 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $95 | 39% | $58 |
| Blood Test - Cholesterol Test, Lipid Panel | $162 | 39% | $99 |
| Blood Test - Clotting Time | $59 | 39% | $36 |
| Blood Test - Coagulation Assessment | $92 | 39% | $56 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $95 | 39% | $58 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $106 | 39% | $65 |
| Blood Test - Comprehensive Metabolic Panel | $160 | 39% | $97 |
| Blood Test - Electrolytes Panel | $83 | 39% | $51 |
| Blood Test - Ferritin (Blood Protein) Level | $160 | 39% | $97 |
| Blood Test - Folic Acid Level | $184 | 39% | $112 |
| Blood Test - General Health Panel | $150 | 39% | $92 |
| Blood Test - Hepatic (Liver) Function Panel | $124 | 39% | $76 |
| Blood Test - Hepatitis C Antibody Level | $132 | 39% | $81 |
| Blood Test - Iron Level | $67 | 39% | $41 |
| Blood Test - Lipase (fat enzyme) Level | $119 | 39% | $72 |
| Blood Test - Pregnancy (Obstetric) Panel | $454 | 39% | $277 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $184 | 39% | $112 |
| Blood Test - Renal (Kidney) Function Panel | $99 | 39% | $60 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $150 | 39% | $92 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $119 | 39% | $72 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $153 | 39% | $94 |
| Blood Test - Vitamin D-3 Level | $216 | 39% | $132 |
| Bone Density Scan (outpatient) | $507 | 39% | $309 |
| Colonoscopy - Diagnostic (outpatient) | $5,537 | 39% | $3,377 |
| Colonoscopy - With Biopsy (outpatient) | $7,626 | 39% | $4,652 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,568 | 39% | $4,006 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,799 | 39% | $2,317 |
| CT Scan - Chest, with Contrast (outpatient) | $2,540 | 39% | $1,549 |
| Destruction of Lesion (outpatient) | $459 | 39% | $280 |
| Detection test for Human Papillomavirus (HPV) | $245 | 39% | $149 |
| Electrocardiogram (ECG or EKG) | $431 | 39% | $263 |
| Emergency Department Visit - Low Complexity (outpatient) | $457 | 39% | $279 |
| Emergency Department Visit - Minor (outpatient) | $267 | 39% | $163 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $714 | 39% | $436 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $100 | 39% | $61 |
| Fetal Non-Stress Test | $678 | 39% | $414 |
| Gall Bladder Surgery (outpatient) | $18,618 | 39% | $11,357 |
| Hernia Repair - Laparoscopic (outpatient) | $20,295 | 39% | $12,380 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $131 | 39% | $80 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $131 | 39% | $80 |
| Lab Test - Detection test for Influenza Virus | $83 | 39% | $51 |
| Lab Test - Smear for Microorganism | $20 | 39% | $12 |
| Mammogram (outpatient) | $998 | 39% | $608 |
| MRI - Back (outpatient) | $3,038 | 39% | $1,853 |
| MRI - Brain (outpatient) | $3,590 | 39% | $2,190 |
| MRI - Knee (outpatient) | $2,823 | 39% | $1,722 |
| MRI - Pelvis (outpatient) | $4,203 | 39% | $2,564 |
| MRI - Shoulder, Elbow, or Wrist | $2,833 | 39% | $1,728 |
| Myocardial Imaging (outpatient) | $6,981 | 39% | $4,259 |
| Office Visit - Basic | $89 | 39% | $54 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $258 | 39% | $158 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $272 | 39% | $166 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $289 | 39% | $176 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $349 | 39% | $213 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $234 | 39% | $143 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $265 | 39% | $161 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $248 | 39% | $151 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | 39% | $151 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $258 | 39% | $158 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $317 | 39% | $193 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $256 | 39% | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $190 | 39% | $116 |
| Office Visit - Established Patient, High Complexity | $377 | 39% | $230 |
| Office Visit - Established Patient, Low Complexity | $174 | 39% | $106 |
| Office Visit - Established Patient, Moderate Complexity | $267 | 39% | $163 |
| Office Visit - New Patient, Low Complexity | $260 | 39% | $159 |
| Office Visit - New Patient, Minor | $286 | 39% | $174 |
| Office Visit - New Patient, Moderate Complexity | $455 | 39% | $277 |
| Pap Test | $197 | 39% | $120 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $79 | 39% | $48 |
| Physical Therapy - Application of Hot or Cold Pack | $45 | 39% | $28 |
| Physical Therapy - High Complexity Evaluation | $348 | 39% | $212 |
| Physical Therapy - Low Complexity Evaluation | $282 | 39% | $172 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $65 | 39% | $40 |
| Physical Therapy - Manual Therapy | $65 | 39% | $40 |
| Physical Therapy - Moderate Complexity Evaluation | $210 | 39% | $128 |
| Physical Therapy - Neuromuscular Reeducation | $65 | 39% | $40 |
| Physical Therapy - Therapeutic Exercises | $154 | 39% | $94 |
| Physical Therapy - Ultrasound Therapy | $67 | 39% | $41 |
| Strep Test (Streptococcus, group A) | $76 | 39% | $46 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $67 | 39% | $41 |
| Ultrasound - Abdominal, Complete | $793 | 39% | $484 |
| Ultrasound - Abdominal, Limited | $755 | 39% | $461 |
| Ultrasound - Breast (outpatient) | $1,514 | 39% | $924 |
| Ultrasound - Head and Neck | $739 | 39% | $451 |
| Ultrasound - Pelvic (outpatient) | $728 | 39% | $444 |
| Ultrasound - Pregnancy (outpatient) | $789 | 39% | $481 |
| Ultrasound - Pregnancy Follow-Up | $561 | 39% | $342 |
| Ultrasound - Transvaginal (non-maternity) | $1,041 | 39% | $635 |
| Urine Test - Automated with Microscope Examination | $66 | 39% | $40 |
| Urine Test - Automated without Microscope | $66 | 39% | $40 |
| Urine Test - Bacterial Culture | $67 | 39% | $41 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $54 | 39% | $33 |
| Urine Test - Chlamydia | $148 | 39% | $90 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $143 | 39% | $87 |
| Urine Test - Pregnancy | $48 | 39% | $29 |
| Urine Test - Urinalysis, Manual Test | $14 | 39% | $8 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $330 | 39% | $201 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $88 | 39% | $54 |
| X-Ray - Abdomen | $515 | 39% | $314 |
| X-Ray - Ankle (outpatient) | $327 | 39% | $199 |
| X-Ray - Chest (outpatient) | $538 | 39% | $328 |
| X-Ray - Foot (outpatient) | $667 | 39% | $407 |
| X-Ray - Hand | $610 | 39% | $372 |
| X-Ray - Hip | $512 | 39% | $312 |
| X-Ray - Knee (outpatient) | $431 | 39% | $263 |
| X-Ray - Middle Back, Thoracic Spine | $522 | 39% | $318 |
| X-Ray - Neck, Cervical Spine | $521 | 39% | $318 |
| X-Ray - Shoulder (outpatient) | $359 | 39% | $219 |
| X-Ray - Spine (outpatient) | $502 | 39% | $306 |
| X-Ray - Wrist (outpatient) | $538 | 39% | $328 |
