The recent growth in outpatient services has been the result of both increased use of new and improved technology, along with a shift to an ambulatory set ting for many previously performed inpatient tests and procedures. Employers have seen an almost un checked rapid growth in this portion of health care costs, with no signs of slowing down. This article attempts to show a basic step-by-step approach to identifying and reviewing some of the major cost generators through a managed care program.