| Arthrocentesis (outpatient) | $1,420 | 62% | $540 | 
High |
| Arthroscopic Knee Surgery (outpatient) | $12,134 | 62% | $4,611 | 
Medium |
| Arthroscopic Shoulder Surgery | $36,196 | 62% | $13,754 |
Medium |
| Biopsy - Breast | $7,726 | 62% | $2,936 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,285 | 62% | $488 |
Medium |
| Blood Test - Basic Metabolic Panel | $108 | 62% | $41 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $128 | 62% | $49 |
Medium |
| Blood Test - Clotting Time | $70 | 62% | $27 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $71 | 62% | $27 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $97 | 62% | $37 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $202 | 62% | $77 |
Medium |
| Blood Test - Electrolytes Panel | $78 | 62% | $30 |
Medium |
| Blood Test - General Health Panel | $301 | 62% | $115 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $87 | 62% | $33 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $249 | 62% | $95 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $141 | 62% | $53 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $96 | 62% | $37 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $169 | 62% | $64 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $169 | 62% | $64 |
Medium |
| Blood Test - Vitamin D-3 Level | $204 | 62% | $78 |
Medium |
| Bone Density Scan (outpatient) | $594 | 62% | $226 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,400 | 62% | $2,052 |
High |
| Colonoscopy - With Biopsy (outpatient) | $7,832 | 62% | $2,976 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $8,272 | 62% | $3,143 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,427 | 62% | $2,062 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,463 | 62% | $1,316 |
Medium |
| CT Scan - Head/Brain, without Contrast | $2,345 | 62% | $891 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $412 | 62% | $157 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $339 | 62% | $129 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $799 | 62% | $304 |
Medium |
| Fetal Non-Stress Test | $868 | 62% | $330 |
Medium |
| Gall Bladder Surgery (outpatient) | $21,892 | 62% | $8,319 |
Medium |
| Mammogram (outpatient) | $683 | 62% | $260 |
Medium |
| MRI - Back (outpatient) | $3,237 | 62% | $1,230 |
Medium |
| MRI - Brain (outpatient) | $4,780 | 62% | $1,817 |
High |
| MRI - Knee (outpatient) | $3,324 | 62% | $1,263 |
Medium |
| MRI - Pelvis (outpatient) | $6,000 | 62% | $2,280 |
High |
| MRI - Shoulder, Elbow, or Wrist | $3,689 | 62% | $1,402 |
High |
| Myocardial Imaging (outpatient) | $7,406 | 62% | $2,814 |
Medium |
| Office Visit - Basic | $141 | 62% | $54 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $349 | 62% | $133 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $280 | 62% | $106 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $302 | 62% | $115 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $367 | 62% | $139 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | 62% | $86 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $241 | 62% | $92 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $281 | 62% | $107 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $315 | 62% | $120 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $253 | 62% | $96 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $264 | 62% | $100 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $281 | 62% | $107 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $270 | 62% | $103 |
Medium |
| Office Visit - Established Patient, High Complexity | $331 | 62% | $126 |
Medium |
| Office Visit - Established Patient, Low Complexity | $187 | 62% | $71 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $209 | 62% | $79 |
Medium |
| Office Visit - New Patient, Low Complexity | $197 | 62% | $75 |
Medium |
| Office Visit - New Patient, Minor | $193 | 62% | $73 |
Medium |
| Pap Test | $166 | 62% | $63 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $75 | 62% | $28 |
Medium |
| Physical Therapy - High Complexity Evaluation | $445 | 62% | $169 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $224 | 62% | $85 |
Medium |
| Physical Therapy - Manual Therapy | $115 | 62% | $44 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $334 | 62% | $127 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $118 | 62% | $45 |
Medium |
| Physical Therapy - Re-Evaluation | $223 | 62% | $85 |
Medium |
| Physical Therapy - Therapeutic Activities | $142 | 62% | $54 |
Medium |
| Physical Therapy - Therapeutic Exercises | $115 | 62% | $44 |
Medium |
| Physical Therapy - Ultrasound Therapy | $109 | 62% | $42 |
Medium |
| Strep Test (Streptococcus, group A) | $44 | 62% | $17 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $80 | 62% | $30 |
Medium |
| Ultrasound - Abdominal, Complete | $1,173 | 62% | $446 |
Medium |
| Ultrasound - Abdominal, Limited | $698 | 62% | $265 |
Medium |
| Ultrasound - Breast (outpatient) | $1,155 | 62% | $439 |
Medium |
| Ultrasound - Head and Neck | $1,056 | 62% | $401 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,056 | 62% | $401 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $1,046 | 62% | $398 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $745 | 62% | $283 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,089 | 62% | $414 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $9,805 | 62% | $3,726 |
Medium |
| Urine Capacity Measurement | $674 | 62% | $256 |
Medium |
| Urine Test - Automated with Microscope Examination | $77 | 62% | $29 |
Medium |
| Urine Test - Automated without Microscope | $18 | 62% | $7 |
Medium |
| Urine Test - Bacterial Culture | $79 | 62% | $30 |
Medium |
| Urine Test - Chlamydia | $213 | 62% | $81 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $213 | 62% | $81 |
Medium |
| Urine Test - Pregnancy | $78 | 62% | $30 |
Medium |
| X-Ray - Abdomen | $612 | 62% | $233 |
Medium |
| X-Ray - Ankle (outpatient) | $655 | 62% | $249 |
High |
| X-Ray - Chest (outpatient) | $641 | 62% | $244 |
Medium |
| X-Ray - Foot (outpatient) | $659 | 62% | $250 |
Medium |
| X-Ray - Hand | $835 | 62% | $317 |
Medium |
| X-Ray - Hip | $579 | 62% | $220 |
Medium |
| X-Ray - Knee (outpatient) | $938 | 62% | $356 |
Medium |
| X-Ray - Neck, Cervical Spine | $777 | 62% | $295 |
Medium |
| X-Ray - Pelvis | $938 | 62% | $357 |
High |
| X-Ray - Shoulder (outpatient) | $757 | 62% | $288 |
Medium |
| X-Ray - Spine (outpatient) | $817 | 62% | $310 |
Medium |
| X-Ray - Wrist (outpatient) | $713 | 62% | $271 |
Medium |
