| Blood Test - Basic Metabolic Panel | $66 | 40% | $40 | 
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 40% | $54 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $118 | 40% | $71 |
Medium |
| Blood Test - Clotting Time | $53 | 40% | $32 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $62 | 40% | $37 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 40% | $40 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $88 | 40% | $53 |
Medium |
| Blood Test - Electrolytes Panel | $59 | 40% | $35 |
Medium |
| Blood Test - General Health Panel | $306 | 40% | $183 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $69 | 40% | $42 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $127 | 40% | $76 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $84 | 40% | $50 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 40% | $91 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $76 | 40% | $45 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $102 | 40% | $61 |
Medium |
| Blood Test - Vitamin D-3 Level | $306 | 40% | $183 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,755 | 40% | $3,453 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $7,453 | 40% | $4,472 | 
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,762 | 40% | $3,457 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $543 | 40% | $326 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $216 | 40% | $130 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $727 | 40% | $436 |
Medium |
| Mammogram (outpatient) | $665 | 40% | $399 |
Medium |
| MRI - Back (outpatient) | $1,575 | 40% | $945 |
Medium |
| MRI - Knee (outpatient) | $1,513 | 40% | $908 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $1,364 | 40% | $818 |
Medium |
| Office Visit - Basic | $105 | 40% | $63 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $184 | 40% | $110 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $263 | 40% | $158 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $184 | 40% | $110 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $184 | 40% | $110 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $236 | 40% | $142 |
Medium |
| Office Visit - Established Patient, High Complexity | $394 | 40% | $236 |
Medium |
| Office Visit - Established Patient, Low Complexity | $131 | 40% | $79 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $315 | 40% | $189 |
Medium |
| Office Visit - New Patient, Low Complexity | $263 | 40% | $158 |
Medium |
| Office Visit - New Patient, Minor | $116 | 40% | $69 |
Medium |
| Pap Test | $197 | 40% | $118 |
Medium |
| Physical Therapy - High Complexity Evaluation | $334 | 40% | $200 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $334 | 40% | $200 |
Medium |
| Physical Therapy - Manual Therapy | $143 | 40% | $86 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $334 | 40% | $200 |
Medium |
| Physical Therapy - Re-Evaluation | $200 | 40% | $120 |
Medium |
| Physical Therapy - Therapeutic Activities | $143 | 40% | $86 |
Medium |
| Physical Therapy - Therapeutic Exercises | $143 | 40% | $86 |
Medium |
| Strep Test (Streptococcus, group A) | $26 | 40% | $16 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $62 | 40% | $37 |
Medium |
| Ultrasound - Abdominal, Limited | $945 | 40% | $567 |
Medium |
| Ultrasound - Breast (outpatient) | $1,200 | 40% | $720 |
Medium |
| Ultrasound - Head and Neck | $944 | 40% | $566 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,419 | 40% | $851 |
Medium |
| Urine Test - Automated with Microscope Examination | $47 | 40% | $28 |
Medium |
| Urine Test - Automated without Microscope | $41 | 40% | $25 |
Medium |
| Urine Test - Bacterial Culture | $69 | 40% | $42 |
Medium |
| Urine Test - Chlamydia | $219 | 40% | $131 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $219 | 40% | $131 |
Medium |
| Urine Test - Pregnancy | $45 | 40% | $27 |
Medium |
| X-Ray - Ankle (outpatient) | $350 | 40% | $210 |
Medium |
| X-Ray - Chest (outpatient) | $342 | 40% | $205 |
Medium |
| X-Ray - Foot (outpatient) | $350 | 40% | $210 |
Medium |
| X-Ray - Hand | $746 | 40% | $448 |
High |
| X-Ray - Hip | $670 | 40% | $402 |
High |
| X-Ray - Shoulder (outpatient) | $556 | 40% | $334 |
Medium |
| X-Ray - Spine (outpatient) | $795 | 40% | $477 |
Medium |
