| Arthrocentesis (outpatient) | $1,441 | 61% | $562 | 
High |
| Arthroscopic Shoulder Surgery | $51,444 | 61% | $20,063 |
High |
| Bacterial Culture Swab | $107 | 61% | $42 | 
Medium |
| Biopsy - Breast | $8,858 | 61% | $3,455 |
Medium |
| Biopsy - Endometrial (Uterus) | $1,856 | 61% | $724 |
High |
| Blood Test - Basic Metabolic Panel | $108 | 61% | $42 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $130 | 61% | $51 |
Medium |
| Blood Test - Clotting Time | $74 | 61% | $29 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $71 | 61% | $28 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $98 | 61% | $38 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $203 | 61% | $79 |
Medium |
| Blood Test - Electrolytes Panel | $80 | 61% | $31 |
Medium |
| Blood Test - Folic Acid Level | $149 | 61% | $58 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $88 | 61% | $34 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $129 | 61% | $50 |
Medium |
| Blood Test - LDL Cholesterol Level | $89 | 61% | $35 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $111 | 61% | $43 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $488 | 61% | $190 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $148 | 61% | $58 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $104 | 61% | $41 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $169 | 61% | $66 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $169 | 61% | $66 |
Medium |
| Blood Test - Vitamin D-3 Level | $288 | 61% | $112 |
Medium |
| Bone Density Scan (outpatient) | $594 | 61% | $232 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,984 | 61% | $2,334 |
High |
| Colonoscopy - With Biopsy (outpatient) | $8,343 | 61% | $3,254 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $8,597 | 61% | $3,353 |
Medium |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,900 | 61% | $2,301 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $3,820 | 61% | $1,490 |
Medium |
| CT Scan - Head/Brain, without Contrast | $2,345 | 61% | $914 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $253 | 61% | $99 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $428 | 61% | $167 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $339 | 61% | $132 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $831 | 61% | $324 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $101 | 61% | $39 |
Medium |
| Fetal Non-Stress Test | $626 | 61% | $244 |
Medium |
| Gall Bladder Surgery (outpatient) | $26,010 | 61% | $10,144 |
Medium |
| Mammogram (outpatient) | $711 | 61% | $277 |
Medium |
| MRI - Back (outpatient) | $3,237 | 61% | $1,262 |
Medium |
| MRI - Brain (outpatient) | $5,161 | 61% | $2,013 |
High |
| MRI - Knee (outpatient) | $3,467 | 61% | $1,352 |
High |
| MRI - Pelvis (outpatient) | $6,191 | 61% | $2,414 |
High |
| MRI - Shoulder, Elbow, or Wrist | $3,770 | 61% | $1,470 |
Medium |
| Myocardial Imaging (outpatient) | $7,404 | 61% | $2,887 |
Medium |
| Office Visit - Basic | $69 | 61% | $27 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | 61% | $89 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $256 | 61% | $100 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 61% | $90 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 61% | $105 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | 61% | $88 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | 61% | $87 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | 61% | $75 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $198 | 61% | $77 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $203 | 61% | $79 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $227 | 61% | $88 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | 61% | $74 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | 61% | $76 |
Medium |
| Office Visit - Established Patient, High Complexity | $252 | 61% | $98 |
Medium |
| Office Visit - Established Patient, Low Complexity | $186 | 61% | $72 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $219 | 61% | $86 |
Medium |
| Office Visit - New Patient, Low Complexity | $300 | 61% | $117 |
Medium |
| Office Visit - New Patient, Minor | $230 | 61% | $90 |
Medium |
| Pap Test | $175 | 61% | $68 |
Medium |
| Physical Therapy - Application of Hot or Cold Pack | $62 | 61% | $24 |
Medium |
| Physical Therapy - Electrical Stimulation Therapy | $75 | 61% | $29 |
Medium |
| Physical Therapy - High Complexity Evaluation | $445 | 61% | $174 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $224 | 61% | $87 |
Medium |
| Physical Therapy - Manual Therapy | $116 | 61% | $45 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $335 | 61% | $131 |
Medium |
| Physical Therapy - Re-Evaluation | $223 | 61% | $87 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $146 | 61% | $57 |
Medium |
| Physical Therapy - Therapeutic Exercises | $116 | 61% | $45 |
Medium |
| Physical Therapy - Therapeutic Massage | $23 | 61% | $9 |
Medium |
| Physical Therapy - Ultrasound Therapy | $116 | 61% | $45 |
Medium |
| Strep Test (Streptococcus, group A) | $44 | 61% | $17 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $60 | 61% | $23 |
Medium |
| Ultrasound - Abdominal, Complete | $1,224 | 61% | $477 |
Medium |
| Ultrasound - Abdominal, Limited | $728 | 61% | $284 |
Medium |
| Ultrasound - Breast (outpatient) | $1,384 | 61% | $540 |
Medium |
| Ultrasound - Head and Neck | $1,104 | 61% | $430 |
Medium |
| Ultrasound - Pelvic (outpatient) | $1,149 | 61% | $448 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $716 | 61% | $279 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $518 | 61% | $202 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,137 | 61% | $443 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $10,133 | 61% | $3,952 |
Medium |
| Urine Test - Automated with Microscope Examination | $77 | 61% | $30 |
Medium |
| Urine Test - Automated without Microscope | $18 | 61% | $7 |
Medium |
| Urine Test - Bacterial Culture | $61 | 61% | $24 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $80 | 61% | $31 |
Medium |
| Urine Test - Chlamydia | $224 | 61% | $87 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $224 | 61% | $87 |
Medium |
| Urine Test - Pregnancy | $53 | 61% | $20 |
Medium |
| X-Ray - Abdomen | $597 | 61% | $233 |
Medium |
| X-Ray - Ankle (outpatient) | $705 | 61% | $275 |
High |
| X-Ray - Chest (outpatient) | $651 | 61% | $254 |
Medium |
| X-Ray - Foot (outpatient) | $713 | 61% | $278 |
Medium |
| X-Ray - Hand | $823 | 61% | $321 |
Medium |
| X-Ray - Hip | $599 | 61% | $234 |
Medium |
| X-Ray - Knee (outpatient) | $990 | 61% | $386 |
Medium |
| X-Ray - Neck, Cervical Spine | $810 | 61% | $316 |
Medium |
| X-Ray - Pelvis | $847 | 61% | $330 |
Medium |
| X-Ray - Shoulder (outpatient) | $800 | 61% | $312 |
High |
| X-Ray - Spine (outpatient) | $828 | 61% | $323 |
Medium |
| X-Ray - Wrist (outpatient) | $771 | 61% | $301 |
Medium |
