A new Health Affairs analysis has found that low-cost, low-value, high-volume health services are the biggest culprits in unneeded healthcare spending.

Researchers studying 2014 data from the Virginia All Payer Claims Database of 44 low-value health services found more than $586 million in unnecessary costs in that state.

The study said  that low-cost, low-value services result in nearly twice as much money spent as high-cost ones.

Among the unneeded low-cost services were baseline lab tests for low-risk patients facing low-risk surgery; stress cardiac or other cardiac imaging in low-risk, asymptomatic patients, and annual EKGs or other cardiac screening for low-risk, asymptomatic patients.

Small actions by clinicians “can have a sizable impact on reducing unnecessary healthcare spending,” according to the report. Further, the authors suggested, cutting back on low-value, low-cost services wouldn’t be as “politically charged” as reducing higher-profile but lower-value services.

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