| Arthrocentesis (outpatient) | $1,028 | 45% | $565 | 
Medium |
| Bacterial Culture Swab | $100 | 45% | $55 |
Medium |
| Blood Test - Basic Metabolic Panel | $100 | 45% | $55 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $88 | 45% | $49 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $151 | 45% | $83 |
Medium |
| Blood Test - Clotting Time | $45 | 45% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $74 | 45% | $40 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $89 | 45% | $49 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $121 | 45% | $66 |
Medium |
| Blood Test - Folic Acid Level | $68 | 45% | $38 |
Medium |
| Blood Test - General Health Panel | $352 | 45% | $193 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $95 | 45% | $52 |
Medium |
| Blood Test - Hepatitis C Antibody Level | $152 | 45% | $84 |
Medium |
| Blood Test - LDL Cholesterol Level | $44 | 45% | $24 |
Medium |
| Blood Test - Lipase (fat enzyme) Level | $78 | 45% | $43 |
Medium |
| Blood Test - Pregnancy (Obstetric) Panel | $541 | 45% | $297 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $166 | 45% | $91 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $72 | 45% | $40 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $142 | 45% | $78 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $114 | 45% | $63 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $135 | 45% | $74 |
Medium |
| Blood Test - Vitamin D-3 Level | $208 | 45% | $114 |
Medium |
| Bone Density Scan (outpatient) | $539 | 45% | $296 | 
High |
| Colonoscopy - Diagnostic (outpatient) | $4,221 | 45% | $2,321 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $5,383 | 45% | $2,961 |
Medium |
| Colonoscopy - With Polyp Removal (outpatient) | $6,859 | 45% | $3,773 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,983 | 45% | $2,741 |
Medium |
| CT Scan - Chest, with Contrast (outpatient) | $2,953 | 45% | $1,624 |
Medium |
| Detection Test for Human Papillomavirus (HPV) | $294 | 45% | $162 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $317 | 45% | $174 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $193 | 45% | $106 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $606 | 45% | $333 |
Medium |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $102 | 45% | $56 |
Medium |
| Mammogram (outpatient) | $792 | 45% | $435 |
Medium |
| MRI - Back (outpatient) | $4,066 | 45% | $2,236 |
Medium |
| MRI - Brain (outpatient) | $5,903 | 45% | $3,247 |
Medium |
| MRI - Knee (outpatient) | $3,590 | 45% | $1,974 |
Medium |
| MRI - Shoulder, Elbow, or Wrist | $3,865 | 45% | $2,126 |
Medium |
| Office Visit - Basic | $95 | 45% | $52 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | 45% | $144 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $284 | 45% | $156 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $288 | 45% | $158 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $332 | 45% | $182 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $243 | 45% | $133 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $225 | 45% | $124 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | 45% | $136 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $248 | 45% | $136 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $270 | 45% | $148 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $228 | 45% | $125 |
Medium |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $201 | 45% | $110 |
Medium |
| Office Visit - Established Patient, High Complexity | $253 | 45% | $139 |
Medium |
| Office Visit - Established Patient, Low Complexity | $128 | 45% | $70 |
Medium |
| Office Visit - Established Patient, Moderate Complexity | $188 | 45% | $103 |
Medium |
| Office Visit - New Patient, Low Complexity | $213 | 45% | $117 |
Medium |
| Office Visit - New Patient, Minor | $158 | 45% | $87 |
Medium |
| Pap Test | $155 | 45% | $85 |
Medium |
| Physical Therapy - High Complexity Evaluation | $298 | 45% | $164 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $301 | 45% | $166 |
Medium |
| Physical Therapy - Manual Therapy | $144 | 45% | $79 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $301 | 45% | $166 |
Medium |
| Physical Therapy - Neuromuscular Reeducation | $111 | 45% | $61 |
Medium |
| Physical Therapy - Re-Evaluation | $181 | 45% | $99 |
Medium |
| Physical Therapy - Self-care or Home Management Training | $98 | 45% | $54 |
Medium |
| Physical Therapy - Therapeutic Activities | $111 | 45% | $61 |
Medium |
| Physical Therapy - Therapeutic Exercises | $122 | 45% | $67 |
Medium |
| Physical Therapy - Ultrasound Therapy | $48 | 45% | $27 |
Medium |
| Strep Test (Streptococcus, group A) | $24 | 45% | $13 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $71 | 45% | $39 |
Medium |
| Ultrasound - Abdominal, Complete | $1,265 | 45% | $696 |
Medium |
| Ultrasound - Abdominal, Limited | $738 | 45% | $406 |
Medium |
| Ultrasound - Breast (outpatient) | $1,072 | 45% | $590 |
Medium |
| Ultrasound - Head and Neck | $802 | 45% | $441 |
High |
| Ultrasound - Pregnancy (outpatient) | $1,023 | 45% | $562 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,239 | 45% | $681 |
Medium |
| Urine Test - Automated with Microscope Examination | $38 | 45% | $21 |
Medium |
| Urine Test - Automated without Microscope | $30 | 45% | $17 |
Medium |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $67 | 45% | $37 |
Medium |
| Urine Test - Chlamydia | $109 | 45% | $60 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $109 | 45% | $60 |
Medium |
| Urine Test - Pregnancy | $71 | 45% | $39 |
Medium |
| X-Ray - Abdomen | $786 | 45% | $432 |
Medium |
| X-Ray - Ankle (outpatient) | $518 | 45% | $285 |
Medium |
| X-Ray - Chest (outpatient) | $549 | 45% | $302 |
Medium |
| X-Ray - Foot (outpatient) | $522 | 45% | $287 |
Medium |
| X-Ray - Hand | $553 | 45% | $304 |
Medium |
| X-Ray - Hip | $700 | 45% | $385 |
Medium |
| X-Ray - Knee (outpatient) | $618 | 45% | $340 |
Medium |
| X-Ray - Shoulder (outpatient) | $502 | 45% | $276 |
Medium |
| X-Ray - Spine (outpatient) | $488 | 45% | $269 |
Medium |
| X-Ray - Wrist (outpatient) | $515 | 45% | $283 |
High |
