| Arthrocentesis (outpatient) | $1,660 | 61% | $647 |
| Arthroscopic Shoulder Surgery | $55,164 | 61% | $21,514 |
| Bacterial Culture - Aerobic Isolates | $83 | 61% | $32 |
| Bacterial Culture - Swab | $107 | 61% | $42 |
| Biopsy - Breast | $8,480 | 61% | $3,307 |
| Biopsy - Endometrial (Uterus) | $1,659 | 61% | $647 |
| Blood Test - Basic Metabolic Panel | $114 | 61% | $45 |
| Blood Test - Cholesterol Test, Lipid Panel | $138 | 61% | $54 |
| Blood Test - Clotting Time | $78 | 61% | $30 |
| Blood Test - Coagulation Assessment | $93 | 61% | $36 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $76 | 61% | $29 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $103 | 61% | $40 |
| Blood Test - Comprehensive Metabolic Panel | $213 | 61% | $83 |
| Blood Test - Electrolytes Panel | $80 | 61% | $31 |
| Blood Test - Ferritin (Blood Protein) Level | $140 | 61% | $54 |
| Blood Test - Folic Acid Level | $158 | 61% | $61 |
| Blood Test - Hepatic (Liver) Function Panel | $93 | 61% | $36 |
| Blood Test - Hepatitis C Antibody Level | $137 | 61% | $53 |
| Blood Test - Iron Level | $66 | 61% | $26 |
| Blood Test - LDL Cholesterol Level | $95 | 61% | $37 |
| Blood Test - Lipase (fat enzyme) Level | $118 | 61% | $46 |
| Blood Test - Pregnancy (Obstetric) Panel | $488 | 61% | $190 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $148 | 61% | $58 |
| Blood Test - Renal (Kidney) Function Panel | $107 | 61% | $42 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $179 | 61% | $70 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $205 | 61% | $80 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $249 | 61% | $97 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $179 | 61% | $70 |
| Blood Test - Vitamin D-3 Level | $302 | 61% | $118 |
| Bone Density Scan (outpatient) | $621 | 61% | $242 |
| Colonoscopy - Diagnostic (outpatient) | $6,043 | 61% | $2,357 |
| Colonoscopy - With Biopsy (outpatient) | $8,399 | 61% | $3,276 |
| Colonoscopy - With Polyp Removal (outpatient) | $8,792 | 61% | $3,429 |
| CT Scan - Abdomen and Pelvis, with Contrast | $6,095 | 61% | $2,377 |
| CT Scan - Chest, with Contrast (outpatient) | $3,820 | 61% | $1,490 |
| CT Scan - Head/Brain, without Contrast | $2,451 | 61% | $956 |
| Detection test for Human Papillomavirus (HPV) | $267 | 61% | $104 |
| Emergency Department Visit - Low Complexity (outpatient) | $450 | 61% | $176 |
| Emergency Department Visit - Minor (outpatient) | $357 | 61% | $139 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $873 | 61% | $340 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $106 | 61% | $41 |
| Fetal Non-Stress Test | $1,616 | 61% | $630 |
| Gall Bladder Surgery (outpatient) | $26,061 | 61% | $10,164 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $106 | 61% | $41 |
| Lab Test - Detection test for Influenza Virus | $118 | 61% | $46 |
| Lab Test - Smear for Microorganism | $61 | 61% | $24 |
| Mammogram (outpatient) | $737 | 61% | $287 |
| MRI - Back (outpatient) | $3,382 | 61% | $1,319 |
| MRI - Brain (outpatient) | $5,257 | 61% | $2,050 |
| MRI - Knee (outpatient) | $3,628 | 61% | $1,415 |
| MRI - Pelvis (outpatient) | $6,239 | 61% | $2,433 |
| MRI - Shoulder, Elbow, or Wrist | $3,942 | 61% | $1,537 |
| Myocardial Imaging (outpatient) | $7,582 | 61% | $2,957 |
| Office Visit - Basic | $69 | 61% | $27 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | 61% | $89 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $280 | 61% | $109 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 61% | $90 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 61% | $105 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | 61% | $88 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | 61% | $87 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | 61% | $75 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $209 | 61% | $81 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $213 | 61% | $83 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $227 | 61% | $88 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | 61% | $74 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | 61% | $76 |
| Office Visit - Established Patient, High Complexity | $252 | 61% | $98 |
| Office Visit - Established Patient, Low Complexity | $186 | 61% | $72 |
| Office Visit - Established Patient, Moderate Complexity | $219 | 61% | $86 |
| Office Visit - New Patient, Low Complexity | $300 | 61% | $117 |
| Office Visit - New Patient, Minor | $230 | 61% | $90 |
| Office Visit - New Patient, Moderate Complexity | $400 | 61% | $156 |
| Pap Test | $271 | 61% | $106 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 61% | $20 |
| Physical Therapy - Application of Hot or Cold Pack | $65 | 61% | $25 |
| Physical Therapy - Application of Mechanical Traction | $53 | 61% | $20 |
| Physical Therapy - Electrical Stimulation Therapy | $79 | 61% | $31 |
| Physical Therapy - High Complexity Evaluation | $468 | 61% | $183 |
| Physical Therapy - Low Complexity Evaluation | $235 | 61% | $92 |
| Physical Therapy - Manual Therapy | $122 | 61% | $48 |
| Physical Therapy - Moderate Complexity Evaluation | $352 | 61% | $137 |
| Physical Therapy - Self-care or Home Management Training | $153 | 61% | $60 |
| Physical Therapy - Therapeutic Activities | $79 | 61% | $31 |
| Physical Therapy - Therapeutic Exercises | $122 | 61% | $48 |
| Physical Therapy - Ultrasound Therapy | $122 | 61% | $48 |
| Strep Test (Streptococcus, group A) | $84 | 61% | $33 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $60 | 61% | $23 |
| Ultrasound - Abdominal, Complete | $1,224 | 61% | $477 |
| Ultrasound - Abdominal, Limited | $728 | 61% | $284 |
| Ultrasound - Breast (outpatient) | $1,576 | 61% | $614 |
| Ultrasound - Head and Neck | $1,104 | 61% | $430 |
| Ultrasound - Pelvic (outpatient) | $1,149 | 61% | $448 |
| Ultrasound - Pregnancy (outpatient) | $730 | 61% | $285 |
| Ultrasound - Pregnancy Follow-Up | $701 | 61% | $274 |
| Ultrasound - Transvaginal (non-maternity) | $1,235 | 61% | $482 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,080 | 61% | $1,981 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $10,391 | 61% | $4,052 |
| Urine Capacity Measurement | $605 | 61% | $236 |
| Urine Test - Automated with Microscope Examination | $81 | 61% | $32 |
| Urine Test - Automated without Microscope | $19 | 61% | $7 |
| Urine Test - Bacterial Culture | $64 | 61% | $25 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $84 | 61% | $33 |
| Urine Test - Chlamydia | $253 | 61% | $99 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $253 | 61% | $99 |
| Urine Test - Microalbumin (Protein) Level | $95 | 61% | $37 |
| Urine Test - Pregnancy | $53 | 61% | $20 |
| Urine Test - Urinalysis, Manual Test | $27 | 61% | $11 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $197 | 61% | $77 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | 61% | $27 |
| X-Ray - Abdomen | $613 | 61% | $239 |
| X-Ray - Ankle (outpatient) | $739 | 61% | $288 |
| X-Ray - Chest (outpatient) | $651 | 61% | $254 |
| X-Ray - Foot (outpatient) | $748 | 61% | $292 |
| X-Ray - Hand | $823 | 61% | $321 |
| X-Ray - Hip | $615 | 61% | $240 |
| X-Ray - Knee (outpatient) | $1,028 | 61% | $401 |
| X-Ray - Neck, Cervical Spine | $814 | 61% | $317 |
| X-Ray - Pelvis | $893 | 61% | $348 |
| X-Ray - Shoulder (outpatient) | $804 | 61% | $314 |
| X-Ray - Spine (outpatient) | $848 | 61% | $331 |
| X-Ray - Wrist (outpatient) | $809 | 61% | $315 |
