| Arthrocentesis (outpatient) | $1,392 | 40% | $835 | 
Medium |
| Arthroscopic Knee Surgery (outpatient) | $13,801 | 40% | $8,281 |
Medium |
| Arthroscopic Shoulder Surgery | $44,551 | 40% | $26,730 |
Medium |
| Biopsy - Breast | $12,401 | 40% | $7,441 | 
High |
| Blood Test - Basic Metabolic Panel | $43 | 40% | $26 |
Medium |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $90 | 40% | $54 |
Medium |
| Blood Test - Cholesterol Test, Lipid Panel | $95 | 40% | $57 |
Medium |
| Blood Test - Clotting Time | $72 | 40% | $43 |
Medium |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $42 | 40% | $25 |
Medium |
| Blood Test - Complete Blood Cell Count and Automated WBC | $104 | 40% | $62 |
Medium |
| Blood Test - Comprehensive Metabolic Panel | $51 | 40% | $31 |
Medium |
| Blood Test - Electrolytes Panel | $64 | 40% | $38 |
Medium |
| Blood Test - General Health Panel | $189 | 40% | $113 |
Medium |
| Blood Test - Hepatic (Liver) Function Panel | $45 | 40% | $27 |
Medium |
| Blood Test - Prostate Specific Antigen (PSA) Level | $104 | 40% | $62 |
Medium |
| Blood Test - Renal (Kidney) Function Panel | $35 | 40% | $21 |
Medium |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $97 | 40% | $58 |
Medium |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $69 | 40% | $42 |
Medium |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $87 | 40% | $52 |
Medium |
| Blood Test - Vitamin D-3 Level | $208 | 40% | $125 |
Medium |
| Colonoscopy - Diagnostic (outpatient) | $5,920 | 40% | $3,552 |
Medium |
| Colonoscopy - With Biopsy (outpatient) | $7,213 | 40% | $4,328 |
High |
| Colonoscopy - With Polyp Removal (outpatient) | $7,433 | 40% | $4,460 |
High |
| CT Scan - Abdomen and Pelvis, with Contrast | $6,934 | 40% | $4,161 |
High |
| CT Scan - Chest, with Contrast (outpatient) | $4,010 | 40% | $2,406 |
Medium |
| CT Scan - Head/Brain, without Contrast | $3,403 | 40% | $2,042 |
Medium |
| Cystoscopy | $2,182 | 40% | $1,309 |
Medium |
| Emergency Department Visit - Low Complexity (outpatient) | $407 | 40% | $244 |
Medium |
| Emergency Department Visit - Minor (outpatient) | $210 | 40% | $126 |
Medium |
| Emergency Department Visit - Moderate Complexity (outpatient) | $677 | 40% | $406 |
Medium |
| Fetal Non-Stress Test | $905 | 40% | $543 |
Medium |
| Gall Bladder Surgery (outpatient) | $33,997 | 40% | $20,398 |
Medium |
| Hernia Repair - Laparoscopic (outpatient) | $32,585 | 40% | $19,551 |
High |
| Kidney Stone Removal (outpatient) | $22,189 | 40% | $13,313 |
High |
| Mammogram (outpatient) | $943 | 40% | $566 |
Medium |
| MRI - Brain (outpatient) | $7,621 | 40% | $4,573 |
Medium |
| MRI - Knee (outpatient) | $4,403 | 40% | $2,642 |
High |
| MRI - Shoulder, Elbow, or Wrist | $3,654 | 40% | $2,192 |
High |
| Myocardial Imaging (outpatient) | $10,482 | 40% | $6,289 |
Medium |
| Physical Therapy - High Complexity Evaluation | $413 | 40% | $248 |
Medium |
| Physical Therapy - Low Complexity Evaluation | $413 | 40% | $248 |
Medium |
| Physical Therapy - Manual Therapy | $161 | 40% | $96 |
Medium |
| Physical Therapy - Moderate Complexity Evaluation | $413 | 40% | $248 |
Medium |
| Physical Therapy - Therapeutic Activities | $146 | 40% | $88 |
Medium |
| Physical Therapy - Therapeutic Exercises | $142 | 40% | $85 |
Medium |
| Strep Test (Streptococcus, group A) | $100 | 40% | $60 |
Medium |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $55 | 40% | $33 |
Medium |
| Ultrasound - Abdominal, Complete | $1,899 | 40% | $1,140 |
Medium |
| Ultrasound - Abdominal, Limited | $1,250 | 40% | $750 |
Medium |
| Ultrasound - Breast (outpatient) | $1,658 | 40% | $995 |
Medium |
| Ultrasound - Head and Neck | $1,109 | 40% | $665 |
Medium |
| Ultrasound - Pregnancy (outpatient) | $889 | 40% | $534 |
Medium |
| Ultrasound - Pregnancy Follow-Up | $1,166 | 40% | $699 |
Medium |
| Ultrasound - Transvaginal (non-maternity) | $1,003 | 40% | $602 |
High |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,111 | 40% | $3,067 |
Medium |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,514 | 40% | $3,909 |
Medium |
| Urine Capacity Measurement | $571 | 40% | $342 |
High |
| Urine Test - Automated with Microscope Examination | $50 | 40% | $30 |
Medium |
| Urine Test - Automated without Microscope | $20 | 40% | $12 |
Medium |
| Urine Test - Bacterial Culture | $50 | 40% | $30 |
Medium |
| Urine Test - Chlamydia | $137 | 40% | $82 |
Medium |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $137 | 40% | $82 |
Medium |
| Urine Test - Pregnancy | $57 | 40% | $34 |
Medium |
| X-Ray - Abdomen | $777 | 40% | $466 |
Medium |
| X-Ray - Ankle (outpatient) | $747 | 40% | $448 |
Medium |
| X-Ray - Chest (outpatient) | $972 | 40% | $583 |
Medium |
| X-Ray - Foot (outpatient) | $893 | 40% | $536 |
Medium |
| X-Ray - Hand | $898 | 40% | $539 |
Medium |
| X-Ray - Hip | $881 | 40% | $529 |
Medium |
| X-Ray - Knee (outpatient) | $830 | 40% | $498 |
Medium |
| X-Ray - Middle Back, Thoracic Spine | $1,640 | 40% | $984 |
Medium |
| X-Ray - Neck, Cervical Spine | $618 | 40% | $371 |
High |
| X-Ray - Pelvis | $775 | 40% | $465 |
Medium |
| X-Ray - Shoulder (outpatient) | $881 | 40% | $529 |
Medium |
| X-Ray - Spine (outpatient) | $969 | 40% | $581 |
High |
| X-Ray - Wrist (outpatient) | $862 | 40% | $517 |
Medium |
