| Arthrocentesis (outpatient) | $1,363 | N/A | $463 |
| Bacterial Culture - Aerobic Isolates | $87 | N/A | $30 |
| Bacterial Culture - Swab | $146 | N/A | $50 |
| Biopsy - Breast | $8,301 | N/A | $2,822 |
| Biopsy - Punch Biopsy of Skin | $925 | N/A | $315 |
| Blood Test - Basic Metabolic Panel | $76 | N/A | $26 |
| Blood Test - Blood Glucose (Sugar) Level | $49 | N/A | $17 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $101 | N/A | $34 |
| Blood Test - Blood Typing (ABO) | $131 | N/A | $45 |
| Blood Test - C-reactive Protein (CRP) Level | $103 | N/A | $35 |
| Blood Test - Cholesterol Test, Lipid Panel | $138 | N/A | $47 |
| Blood Test - Clotting Time | $53 | N/A | $18 |
| Blood Test - Coagulation Assessment | $76 | N/A | $26 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $67 | N/A | $23 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $90 | N/A | $31 |
| Blood Test - Comprehensive Metabolic Panel | $108 | N/A | $37 |
| Blood Test - Creatinine Level | $69 | N/A | $24 |
| Blood Test - Electrolytes Panel | $95 | N/A | $32 |
| Blood Test - Ferritin (Blood Protein) Level | $147 | N/A | $50 |
| Blood Test - Folic Acid Level | $143 | N/A | $49 |
| Blood Test - General Health Panel | $214 | N/A | $73 |
| Blood Test - Hepatic (Liver) Function Panel | $90 | N/A | $31 |
| Blood Test - Hepatitis B Surface Antibody Level | $137 | N/A | $46 |
| Blood Test - Hepatitis C Antibody Level | $140 | N/A | $47 |
| Blood Test - Iron Binding Capacity | $98 | N/A | $33 |
| Blood Test - Iron Level | $101 | N/A | $34 |
| Blood Test - LDL Cholesterol Level | $88 | N/A | $30 |
| Blood Test - Lead Level | $38 | N/A | $13 |
| Blood Test - Lipase (fat enzyme) Level | $109 | N/A | $37 |
| Blood Test - Magnesium Level | $84 | N/A | $29 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $151 | N/A | $51 |
| Blood Test - Renal (Kidney) Function Panel | $99 | N/A | $34 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $237 | N/A | $81 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $154 | N/A | $52 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $122 | N/A | $41 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $275 | N/A | $94 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $153 | N/A | $52 |
| Blood Test - Vitamin D-3 Level | $234 | N/A | $80 |
| Bone Density Scan (outpatient) | $600 | N/A | $204 |
| Colonoscopy - Diagnostic (outpatient) | $4,104 | N/A | $1,396 |
| Colonoscopy - With Biopsy (outpatient) | $4,364 | N/A | $1,484 |
| Colonoscopy - With Polyp Removal (outpatient) | $4,763 | N/A | $1,620 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,082 | N/A | $1,728 |
| CT Scan - Chest, with Contrast (outpatient) | $2,769 | N/A | $941 |
| CT Scan - Head/Brain, without Contrast | $2,233 | N/A | $759 |
| Developmental Screening | $28 | N/A | $10 |
| Electrocardiogram (ECG or EKG), Tracing | $489 | N/A | $166 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $321 | N/A | $109 |
| Emergency Department Visit - Low Complexity (outpatient) | $491 | N/A | $167 |
| Emergency Department Visit - Minor (outpatient) | $268 | N/A | $91 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,002 | N/A | $341 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $143 | N/A | $49 |
| Fetal Non-Stress Test | $810 | N/A | $275 |
| Hydration Infusion | $219 | N/A | $75 |
| Lab Test - Creatinine Level | $69 | N/A | $24 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $41 | N/A | $14 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $162 | N/A | $55 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $131 | N/A | $45 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $195 | N/A | $66 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $357 | N/A | $121 |
| Lab Test - Detection test for Influenza Virus | $42 | N/A | $14 |
| Lab Test - Smear for Microorganism | $67 | N/A | $23 |
| Mammogram (outpatient) | $995 | N/A | $338 |
| MRI - Back (outpatient) | $3,599 | N/A | $1,224 |
| MRI - Brain (outpatient) | $5,919 | N/A | $2,013 |
| Myocardial Imaging (outpatient) | $12,672 | N/A | $4,309 |
| Office Visit - Basic | $111 | N/A | $38 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | N/A | $89 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $249 | N/A | $85 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $244 | N/A | $83 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $296 | N/A | $101 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $235 | N/A | $80 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $212 | N/A | $72 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | N/A | $65 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $210 | N/A | $71 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $210 | N/A | $71 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $228 | N/A | $77 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | N/A | $65 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $172 | N/A | $59 |
| Office Visit - Established Patient, High Complexity | $359 | N/A | $122 |
| Office Visit - Established Patient, Low Complexity | $210 | N/A | $71 |
| Office Visit - Established Patient, Moderate Complexity | $228 | N/A | $77 |
| Office Visit - New Patient, Low Complexity | $257 | N/A | $87 |
| Office Visit - New Patient, Minor | $215 | N/A | $73 |
| Office Visit - New Patient, Moderate Complexity | $341 | N/A | $116 |
| Physical Therapy - Electrical Stimulation Therapy | $83 | 
Below Average
State Average: 3 | $28 |
| Physical Therapy - High Complexity Evaluation | $327 | 
Near Average
State Average: 1 | $111 |
| Physical Therapy - Low Complexity Evaluation | $341 |
Near Average
State Average: 1 | $116 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $84 |
Below Average
State Average: 3 | $29 |
| Physical Therapy - Manual Therapy | $145 |
Near Average
State Average: 4 | $49 |
| Physical Therapy - Moderate Complexity Evaluation | $341 |
Near Average
State Average: 1 | $116 |
| Physical Therapy - Neuromuscular Reeducation | $89 |
Near Average
State Average: 4 | $30 |
| Physical Therapy - Re-Evaluation | $142 |
Near Average
State Average: 1 | $48 |
| Physical Therapy - Self-care or Home Management Training | $92 |
Near Average
State Average: 1 | $31 |
| Physical Therapy - Therapeutic Activities | $92 |
Near Average
State Average: 3 | $31 |
| Physical Therapy - Therapeutic Exercises | $140 |
Near Average
State Average: 4 | $47 |
| Physical Therapy - Walking Training, 15 minutes | $138 |
Near Average
State Average: 1 | $47 |
| Psychiatric Diagnostic Evaluation | $149 |
Near Average
State Average: 1 | $51 |
| Psychotherapy - 30 Minutes | $84 |
Near Average
State Average: 1 | $29 |
| Psychotherapy - 45 Minutes | $137 |
Below Average
State Average: 4 | $46 |
| Psychotherapy - 60 Minutes | $137 | 
Above Average
State Average: 5 | $46 |
| Psychotherapy - Family Session | $146 |
Below Average
State Average: 3 | $50 |
| Psychotherapy - Group Session | $137 |
Below Average
State Average: 5 | $46 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $83 | N/A | $28 |
| Ultrasound - Abdominal, Complete | $932 | N/A | $317 |
| Ultrasound - Abdominal, Limited | $941 | N/A | $320 |
| Ultrasound - Breast (outpatient) | $961 | N/A | $327 |
| Ultrasound - Head and Neck | $930 | N/A | $316 |
| Ultrasound - Pregnancy (outpatient) | $980 | N/A | $333 |
| Ultrasound - Transvaginal (non-maternity) | $779 | N/A | $265 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,678 | N/A | $1,931 |
| Urine Test - Automated with Microscope Examination | $91 | N/A | $31 |
| Urine Test - Automated without Microscope | $42 | N/A | $14 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $69 | N/A | $24 |
| Urine Test - Microalbumin (Protein) Level | $96 | N/A | $32 |
| Urine Test - Pregnancy | $24 | N/A | $8 |
| Urine Test - Urinalysis, Manual Test | $5 | N/A | $2 |
| Vaccine - Influenza for Injection into Muscle | $25 | N/A | $9 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $307 | N/A | $104 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $77 | N/A | $26 |
| X-Ray - Abdomen | $652 | N/A | $222 |
| X-Ray - Ankle (outpatient) | $425 | N/A | $145 |
| X-Ray - Chest (outpatient) | $499 | N/A | $170 |
| X-Ray - Foot (outpatient) | $455 | N/A | $155 |
| X-Ray - Hand | $420 | N/A | $143 |
| X-Ray - Hip | $651 | N/A | $221 |
| X-Ray - Knee (outpatient) | $448 | N/A | $152 |
| X-Ray - Middle Back, Thoracic Spine | $772 | N/A | $262 |
| X-Ray - Neck, Cervical Spine | $589 | N/A | $200 |
| X-Ray - Shoulder (outpatient) | $425 | N/A | $145 |
| X-Ray - Spine (outpatient) | $547 | N/A | $186 |
| X-Ray - Wrist (outpatient) | $424 | N/A | $144 |
