| Arthrocentesis (outpatient) | $524 | N/A | $367 |
| Arthroscopic Knee Surgery (outpatient) | $11,709 | N/A | $8,196 |
| Bacterial Culture - Aerobic Isolates | $71 | N/A | $50 |
| Bacterial Culture - Swab | $144 | N/A | $101 |
| Blood Test - Basic Metabolic Panel | $161 | N/A | $112 |
| Blood Test - Blood Glucose (Sugar) Level | $45 | N/A | $32 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $111 | N/A | $78 |
| Blood Test - Blood Typing (ABO) | $25 | N/A | $18 |
| Blood Test - Blood Typing (Rh (D)) | $23 | N/A | $16 |
| Blood Test - C-reactive Protein (CRP) Level | $107 | N/A | $75 |
| Blood Test - Cholesterol Test, Lipid Panel | $158 | N/A | $110 |
| Blood Test - Clotting Time | $13 | N/A | $9 |
| Blood Test - Coagulation Assessment | $75 | N/A | $52 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $103 | N/A | $72 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $106 | N/A | $74 |
| Blood Test - Comprehensive Metabolic Panel | $213 | N/A | $149 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $57 | N/A | $40 |
| Blood Test - Creatinine Level | $45 | N/A | $32 |
| Blood Test - Ferritin (Blood Protein) Level | $153 | N/A | $107 |
| Blood Test - Folic Acid Level | $131 | N/A | $92 |
| Blood Test - General Health Panel | $182 | N/A | $127 |
| Blood Test - Hepatic (Liver) Function Panel | $169 | N/A | $118 |
| Blood Test - Hepatitis B Surface Antibody Level | $112 | N/A | $79 |
| Blood Test - Hepatitis C Antibody Level | $138 | N/A | $96 |
| Blood Test - Iron Binding Capacity | $96 | N/A | $67 |
| Blood Test - Iron Level | $60 | N/A | $42 |
| Blood Test - LDL Cholesterol Level | $78 | N/A | $54 |
| Blood Test - Lead Level | $46 | N/A | $32 |
| Blood Test - Lipase (fat enzyme) Level | $137 | N/A | $96 |
| Blood Test - Magnesium Level | $95 | N/A | $66 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $128 | N/A | $90 |
| Blood Test - Renal (Kidney) Function Panel | $128 | N/A | $90 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $107 | N/A | $75 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $148 | N/A | $104 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $158 | N/A | $110 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $149 | N/A | $104 |
| Blood Test - Vitamin D-3 Level | $213 | N/A | $149 |
| Bone Density Scan (outpatient) | $667 | N/A | $467 |
| Colonoscopy - Diagnostic (outpatient) | $5,016 | N/A | $3,512 |
| Colonoscopy - With Biopsy (outpatient) | $6,187 | N/A | $4,331 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,539 | N/A | $2,477 |
| Electrocardiogram (ECG or EKG), Tracing | $600 | N/A | $420 |
| Emergency Department Visit - Low Complexity (outpatient) | $387 | N/A | $271 |
| Emergency Department Visit - Minor (outpatient) | $221 | N/A | $154 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $581 | N/A | $406 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $186 | N/A | $130 |
| Hydration Infusion | $155 | N/A | $109 |
| Lab Test - Creatinine Level | $96 | N/A | $67 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $36 | N/A | $25 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $107 | N/A | $75 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $113 | N/A | $79 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $132 | N/A | $93 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $366 | N/A | $257 |
| Lab Test - Smear for Microorganism | $72 | N/A | $51 |
| Mammogram (outpatient) | $1,218 | N/A | $853 |
| MRI - Back (outpatient) | $3,229 | N/A | $2,260 |
| MRI - Brain (outpatient) | $7,219 | N/A | $5,053 |
| MRI - Knee (outpatient) | $3,415 | N/A | $2,390 |
| MRI - Shoulder, Elbow, or Wrist | $3,311 | N/A | $2,317 |
| Office Visit - Basic | $132 | N/A | $93 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $267 | N/A | $187 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $288 | N/A | $201 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $337 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $251 | N/A | $176 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $246 | N/A | $172 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $223 | N/A | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $243 | N/A | $170 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $244 | N/A | $171 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $267 | N/A | $187 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $221 | N/A | $154 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $200 | N/A | $140 |
| Office Visit - Established Patient, High Complexity | $373 | N/A | $261 |
| Office Visit - Established Patient, Low Complexity | $189 | N/A | $132 |
| Office Visit - Established Patient, Moderate Complexity | $278 | N/A | $195 |
| Office Visit - New Patient, Low Complexity | $360 | N/A | $252 |
| Office Visit - New Patient, Minor | $215 | N/A | $151 |
| Office Visit - New Patient, Moderate Complexity | $326 | N/A | $228 |
| Pap Test, automated screening and manual rescreening | $238 | N/A | $167 |
| Pap Test, manual screening | $137 | N/A | $96 |
| Physical Therapy - Application of Hot or Cold Pack | $63 | 
Below Average
State Average: 3 | $44 |
| Physical Therapy - Electrical Stimulation Therapy | $82 |
Below Average
State Average: 3 | $57 |
| Physical Therapy - High Complexity Evaluation | $380 | 
Near Average
State Average: 1 | $266 |
| Physical Therapy - Low Complexity Evaluation | $211 |
Near Average
State Average: 1 | $148 |
| Physical Therapy - Manual Therapy | $97 |
Below Average
State Average: 4 | $68 |
| Physical Therapy - Moderate Complexity Evaluation | $309 |
Near Average
State Average: 1 | $216 |
| Physical Therapy - Neuromuscular Reeducation | $78 |
Below Average
State Average: 4 | $54 |
| Physical Therapy - Re-Evaluation | $200 |
Near Average
State Average: 1 | $140 |
| Physical Therapy - Self-care or Home Management Training | $54 |
Near Average
State Average: 1 | $37 |
| Physical Therapy - Therapeutic Activities | $68 |
Below Average
State Average: 3 | $48 |
| Physical Therapy - Therapeutic Exercises | $70 |
Below Average
State Average: 4 | $49 |
| Physical Therapy - Ultrasound Therapy | $74 |
Below Average
State Average: 3 | $51 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $144 | N/A | $101 |
| Ultrasound - Abdominal, Limited | $916 | N/A | $641 |
| Ultrasound - Breast (outpatient) | $1,865 | N/A | $1,305 |
| Ultrasound - Head and Neck | $1,216 | N/A | $851 |
| Ultrasound - Pregnancy (outpatient) | $1,232 | N/A | $862 |
| Ultrasound - Pregnancy Follow-Up | $1,109 | N/A | $776 |
| Ultrasound - Transvaginal (non-maternity) | $1,357 | N/A | $950 |
| Urine Test - Automated with Microscope Examination | $40 | N/A | $28 |
| Urine Test - Automated without Microscope | $60 | N/A | $42 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $113 | N/A | $79 |
| Urine Test - Chlamydia | $226 | N/A | $158 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $244 | N/A | $171 |
| Urine Test - Microalbumin (Protein) Level | $98 | N/A | $68 |
| Urine Test - Pregnancy | $20 | N/A | $14 |
| Urine Test - Urinalysis, Manual Test | $9 | N/A | $7 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $27 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $256 | N/A | $179 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $49 | N/A | $35 |
| X-Ray - Ankle (outpatient) | $729 | N/A | $510 |
| X-Ray - Chest (outpatient) | $646 | N/A | $452 |
| X-Ray - Foot (outpatient) | $665 | N/A | $465 |
| X-Ray - Hand | $798 | N/A | $559 |
| X-Ray - Hip | $502 | N/A | $351 |
| X-Ray - Knee (outpatient) | $836 | N/A | $585 |
| X-Ray - Neck, Cervical Spine | $544 | N/A | $381 |
| X-Ray - Pelvis | $597 | N/A | $418 |
| X-Ray - Shoulder (outpatient) | $735 | N/A | $515 |
| X-Ray - Spine (outpatient) | $632 | N/A | $442 |
| X-Ray - Wrist (outpatient) | $803 | N/A | $562 |
