| Arthrocentesis (outpatient) | $433 | 44% | $242 |
| Bacterial Culture - Aerobic Isolates | $119 | 44% | $66 |
| Bacterial Culture - Swab | $77 | 44% | $43 |
| Biopsy - Punch Biopsy of Skin | $1,077 | 44% | $603 |
| Blood Test - Basic Metabolic Panel | $66 | 44% | $37 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 44% | $51 |
| Blood Test - Cholesterol Test, Lipid Panel | $118 | 44% | $66 |
| Blood Test - Clotting Time | $53 | 44% | $29 |
| Blood Test - Coagulation Assessment | $54 | 44% | $30 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $62 | 44% | $35 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $66 | 44% | $37 |
| Blood Test - Comprehensive Metabolic Panel | $88 | 44% | $49 |
| Blood Test - Ferritin (Blood Protein) Level | $119 | 44% | $66 |
| Blood Test - Folic Acid Level | $129 | 44% | $72 |
| Blood Test - General Health Panel | $306 | 44% | $171 |
| Blood Test - Hepatic (Liver) Function Panel | $71 | 44% | $40 |
| Blood Test - Hepatitis C Antibody Level | $119 | 44% | $66 |
| Blood Test - Iron Level | $57 | 44% | $32 |
| Blood Test - LDL Cholesterol Level | $81 | 44% | $45 |
| Blood Test - Lipase (fat enzyme) Level | $61 | 44% | $34 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $127 | 44% | $71 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | 44% | $85 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $81 | 44% | $45 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $151 | 44% | $85 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $105 | 44% | $59 |
| Blood Test - Vitamin D-3 Level | $306 | 44% | $171 |
| Bone Density Scan (outpatient) | $401 | 44% | $225 |
| Colonoscopy - Diagnostic (outpatient) | $3,833 | 44% | $2,146 |
| Colonoscopy - With Biopsy (outpatient) | $5,339 | 44% | $2,990 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,027 | 44% | $3,375 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,524 | 44% | $1,414 |
| Detection test for Human Papillomavirus (HPV) | $185 | 44% | $103 |
| Electrocardiogram (ECG or EKG) | $369 | 44% | $206 |
| Emergency Department Visit - Low Complexity (outpatient) | $539 | 44% | $302 |
| Emergency Department Visit - Minor (outpatient) | $292 | 44% | $163 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $962 | 44% | $539 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $104 | 44% | $58 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $92 | 44% | $52 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $152 | 44% | $85 |
| Lab Test - Detection test for Influenza Virus | $100 | 44% | $56 |
| Lab Test - Smear for Microorganism | $38 | 44% | $21 |
| Mammogram (outpatient) | $433 | 44% | $242 |
| MRI - Back (outpatient) | $3,394 | 44% | $1,900 |
| MRI - Brain (outpatient) | $5,620 | 44% | $3,147 |
| MRI - Knee (outpatient) | $1,929 | 44% | $1,080 |
| MRI - Shoulder, Elbow, or Wrist | $1,926 | 44% | $1,078 |
| Myocardial Imaging (outpatient) | $8,880 | 44% | $4,973 |
| Office Visit - Basic | $88 | 44% | $49 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $320 | 44% | $179 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $348 | 44% | $195 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $404 | 44% | $226 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $319 | 44% | $179 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $296 | 44% | $166 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $278 | 44% | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $302 | 44% | $169 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $303 | 44% | $170 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $332 | 44% | $186 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $277 | 44% | $155 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $251 | 44% | $141 |
| Office Visit - Established Patient, High Complexity | $290 | 44% | $162 |
| Office Visit - Established Patient, Low Complexity | $147 | 44% | $82 |
| Office Visit - Established Patient, Moderate Complexity | $215 | 44% | $121 |
| Office Visit - New Patient, Low Complexity | $216 | 44% | $121 |
| Office Visit - New Patient, Minor | $150 | 44% | $84 |
| Office Visit - New Patient, Moderate Complexity | $330 | 44% | $185 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $150 | 44% | $84 |
| Physical Therapy - Electrical Stimulation Therapy | $68 | 44% | $38 |
| Physical Therapy - High Complexity Evaluation | $355 | 44% | $199 |
| Physical Therapy - Low Complexity Evaluation | $355 | 44% | $199 |
| Physical Therapy - Manual Therapy | $156 | 44% | $88 |
| Physical Therapy - Moderate Complexity Evaluation | $355 | 44% | $199 |
| Physical Therapy - Therapeutic Exercises | $161 | 44% | $90 |
| Physical Therapy - Ultrasound Therapy | $72 | 44% | $41 |
| Psychiatric Diagnostic Evaluation | $259 | 44% | $145 |
| Psychotherapy - 30 Minutes | $126 | 44% | $71 |
| Psychotherapy - 45 Minutes | $167 | 44% | $93 |
| Psychotherapy - Family Session | $231 | 44% | $129 |
| Psychotherapy - Group Session | $53 | 44% | $29 |
| Strep Test (Streptococcus, group A) | $101 | 44% | $56 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $50 | 44% | $28 |
| Ultrasound - Abdominal, Complete | $967 | 44% | $542 |
| Ultrasound - Abdominal, Limited | $757 | 44% | $424 |
| Ultrasound - Head and Neck | $862 | 44% | $483 |
| Ultrasound - Pregnancy (outpatient) | $956 | 44% | $535 |
| Ultrasound - Transvaginal (non-maternity) | $878 | 44% | $492 |
| Urine Test - Automated with Microscope Examination | $47 | 44% | $26 |
| Urine Test - Automated without Microscope | $21 | 44% | $12 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $69 | 44% | $39 |
| Urine Test - Chlamydia | $232 | 44% | $130 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $232 | 44% | $130 |
| Urine Test - Microalbumin (Protein) Level | $47 | 44% | $26 |
| Urine Test - Pregnancy | $56 | 44% | $31 |
| Urine Test - Urinalysis, Manual Test | $23 | 44% | $13 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $374 | 44% | $209 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $75 | 44% | $42 |
| X-Ray - Abdomen | $307 | 44% | $172 |
| X-Ray - Ankle (outpatient) | $266 | 44% | $149 |
| X-Ray - Chest (outpatient) | $527 | 44% | $295 |
| X-Ray - Foot (outpatient) | $322 | 44% | $181 |
| X-Ray - Hand | $485 | 44% | $272 |
| X-Ray - Hip | $519 | 44% | $290 |
| X-Ray - Neck, Cervical Spine | $481 | 44% | $269 |
| X-Ray - Shoulder (outpatient) | $422 | 44% | $236 |
| X-Ray - Spine (outpatient) | $266 | 44% | $149 |
| X-Ray - Wrist (outpatient) | $401 | 44% | $225 |
