| Arthrocentesis (outpatient) | $836 | 45% | $460 |
| Bacterial Culture - Aerobic Isolates | $65 | 45% | $36 |
| Bacterial Culture - Swab | $100 | 45% | $55 |
| Blood Test - Basic Metabolic Panel | $100 | 45% | $55 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | 45% | $19 |
| Blood Test - Cholesterol Test, Lipid Panel | $151 | 45% | $83 |
| Blood Test - Clotting Time | $45 | 45% | $25 |
| Blood Test - Coagulation Assessment | $79 | 45% | $43 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $74 | 45% | $40 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $89 | 45% | $49 |
| Blood Test - Comprehensive Metabolic Panel | $121 | 45% | $66 |
| Blood Test - Ferritin (Blood Protein) Level | $116 | 45% | $64 |
| Blood Test - Folic Acid Level | $68 | 45% | $38 |
| Blood Test - General Health Panel | $352 | 45% | $193 |
| Blood Test - Hepatic (Liver) Function Panel | $95 | 45% | $52 |
| Blood Test - Hepatitis C Antibody Level | $152 | 45% | $84 |
| Blood Test - Iron Level | $75 | 45% | $41 |
| Blood Test - LDL Cholesterol Level | $44 | 45% | $24 |
| Blood Test - Lipase (fat enzyme) Level | $78 | 45% | $43 |
| Blood Test - Pregnancy (Obstetric) Panel | $541 | 45% | $297 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $166 | 45% | $91 |
| Blood Test - Renal (Kidney) Function Panel | $72 | 45% | $40 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $142 | 45% | $78 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $114 | 45% | $63 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $169 | 45% | $93 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $135 | 45% | $74 |
| Blood Test - Vitamin D-3 Level | $208 | 45% | $114 |
| Bone Density Scan (outpatient) | $543 | 45% | $299 |
| Colonoscopy - Diagnostic (outpatient) | $4,174 | 45% | $2,296 |
| Colonoscopy - With Biopsy (outpatient) | $4,860 | 45% | $2,673 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,390 | 45% | $3,514 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,087 | 45% | $2,798 |
| CT Scan - Chest, with Contrast (outpatient) | $3,193 | 45% | $1,756 |
| Detection test for Human Papillomavirus (HPV) | $294 | 45% | $162 |
| Emergency Department Visit - Low Complexity (outpatient) | $323 | 45% | $178 |
| Emergency Department Visit - Minor (outpatient) | $197 | 45% | $109 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $606 | 45% | $333 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $102 | 45% | $56 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $80 | 45% | $44 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $126 | 45% | $69 |
| Lab Test - Detection test for Influenza Virus | $45 | 45% | $25 |
| Lab Test - Smear for Microorganism | $51 | 45% | $28 |
| Mammogram (outpatient) | $914 | 45% | $502 |
| MRI - Back (outpatient) | $4,066 | 45% | $2,236 |
| MRI - Brain (outpatient) | $5,928 | 45% | $3,261 |
| MRI - Knee (outpatient) | $3,590 | 45% | $1,974 |
| MRI - Shoulder, Elbow, or Wrist | $3,915 | 45% | $2,153 |
| Office Visit - Basic | $75 | 45% | $41 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | 45% | $144 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $267 | 45% | $147 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $288 | 45% | $158 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $349 | 45% | $192 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $241 | 45% | $133 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $243 | 45% | $133 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $225 | 45% | $124 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | 45% | $136 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $248 | 45% | $136 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $270 | 45% | $148 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $228 | 45% | $125 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $201 | 45% | $110 |
| Office Visit - Established Patient, High Complexity | $253 | 45% | $139 |
| Office Visit - Established Patient, Low Complexity | $128 | 45% | $70 |
| Office Visit - Established Patient, Moderate Complexity | $188 | 45% | $103 |
| Office Visit - New Patient, Low Complexity | $213 | 45% | $117 |
| Office Visit - New Patient, Minor | $158 | 45% | $87 |
| Office Visit - New Patient, Moderate Complexity | $360 | 45% | $198 |
| Pap Test | $155 | 45% | $85 |
| Physical Therapy - High Complexity Evaluation | $301 | 45% | $166 |
| Physical Therapy - Low Complexity Evaluation | $301 | 45% | $166 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $65 | 45% | $36 |
| Physical Therapy - Manual Therapy | $144 | 45% | $79 |
| Physical Therapy - Moderate Complexity Evaluation | $301 | 45% | $166 |
| Physical Therapy - Re-Evaluation | $181 | 45% | $99 |
| Physical Therapy - Self-care or Home Management Training | $99 | 45% | $54 |
| Physical Therapy - Therapeutic Activities | $111 | 45% | $61 |
| Physical Therapy - Therapeutic Exercises | $122 | 45% | $67 |
| Physical Therapy - Ultrasound Therapy | $63 | 45% | $35 |
| Strep Test (Streptococcus, group A) | $24 | 45% | $13 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $71 | 45% | $39 |
| Ultrasound - Abdominal, Complete | $1,265 | 45% | $696 |
| Ultrasound - Abdominal, Limited | $738 | 45% | $406 |
| Ultrasound - Breast (outpatient) | $1,194 | 45% | $657 |
| Ultrasound - Head and Neck | $802 | 45% | $441 |
| Ultrasound - Transvaginal (non-maternity) | $1,239 | 45% | $681 |
| Urine Test - Automated with Microscope Examination | $38 | 45% | $21 |
| Urine Test - Automated without Microscope | $30 | 45% | $17 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $67 | 45% | $37 |
| Urine Test - Chlamydia | $109 | 45% | $60 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $109 | 45% | $60 |
| Urine Test - Microalbumin (Protein) Level | $71 | 45% | $39 |
| Urine Test - Pregnancy | $71 | 45% | $39 |
| Urine Test - Urinalysis, Manual Test | $19 | 45% | $10 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $210 | 45% | $116 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | 45% | $54 |
| X-Ray - Abdomen | $663 | 45% | $364 |
| X-Ray - Ankle (outpatient) | $558 | 45% | $307 |
| X-Ray - Chest (outpatient) | $627 | 45% | $345 |
| X-Ray - Foot (outpatient) | $558 | 45% | $307 |
| X-Ray - Hand | $568 | 45% | $312 |
| X-Ray - Hip | $646 | 45% | $355 |
| X-Ray - Knee (outpatient) | $622 | 45% | $342 |
| X-Ray - Shoulder (outpatient) | $483 | 45% | $266 |
| X-Ray - Spine (outpatient) | $548 | 45% | $301 |
| X-Ray - Wrist (outpatient) | $560 | 45% | $308 |
