SOURCE Authors’ analysis of data for 2014 from the Virginia All Payer Claims Database. NOTES “Low-value services” refers to forty-four specific health services in specific clinical settings from which the patient is expected to receive no net benefit. The costs for the quartiles of low-value services are less than $100 per very-low-cost service, $100–$538 per low-cost service, $539–$1,315 per high-cost service, and more than $1,315 per very-high-cost service. Costs are the average (mean) amount of money per service paid to a health care provider across all payers, including patients’ out-of-pocket spending, multiplied by the frequency of that service.