EXHIBIT 2.

The 10 most costly low-value services in Virginia, 2014

Low-value service	Mean cost per servicea	Total unnecessary costs (millions)b	Total services measured	Services deemed low value	Ranking by use	Waste indexc
Baseline lab tests for low risk patients having low-risk surgery	$487	$227.8	595,552	467,884	1	78.6%
Stress cardiac or other cardiac imaging in low-risk, asymptomatic patients	$3,404	$93.2	244,487	27,385	13	11.2%
Annual EKGs or other cardiac screening for low-risk, asymptomatic patients	$298	$41.0	2,823,557	137,666	5	4.9%
Routine head CT scans for ED visits for severe dizziness	$1,569	$24.6	29,816	15,724	15	52.7%
EKGs, chest x-rays, or pulmonary function tests in low-risk patients having low-risk surgery	$646	$21.3	33,754	32,900	11	97.5%
Population-based screening for vitamin D deficiency	$125	$20.6	165,034	165,031	4	100.0%
PSA-based screening for prostate cancer in all men, regardless of age	$144	$18.9	341,554	131,419	6	38.5%
Routine imaging for uncomplicated acute rhinosinusitis	$2,365	$17.1	14,196	7,220	19	50.9%
Routine annual cervical cancer screening in women ages 21–65	$91	$15.3	220,241	167,252	3	75.9%
Imaging for low-back pain within the first six weeks of symptom onset, in absence of red flags	$330	$13.9	48,857	42,110	9	86.2%

SOURCE Authors’ analysis of data for 2014 from the Virginia All Payer Claims Database. NOTES “Low-value services” are defined in the Notes to Exhibit 1. EKG is electrocardiogram. CT is computed tomography scan. ED is emergency department. PSA is prostate specific antigen.

^aAverage (mean) amount of money per service paid to a health care provider across all payers (including patients’ out-of-pocket spending).

^bMean cost per service multiplied by total number of low-value services.

^cNumber of low-value services divided by the number of total services measured.