| Arthrocentesis (outpatient) | $1,769 | N/A | $637 |
| Bacterial Culture - Aerobic Isolates | $79 | N/A | $28 |
| Bacterial Culture - Swab | $129 | N/A | $46 |
| Biopsy - Breast | $10,681 | N/A | $3,845 |
| Biopsy - Endometrial (Uterus) | $1,610 | N/A | $579 |
| Blood Test - Basic Metabolic Panel | $68 | N/A | $25 |
| Blood Test - Blood Glucose (Sugar) Level | $43 | N/A | $15 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $91 | N/A | $33 |
| Blood Test - Blood Typing (ABO) | $71 | N/A | $26 |
| Blood Test - Blood Typing (Rh (D)) | $71 | N/A | $26 |
| Blood Test - C-reactive Protein (CRP) Level | $120 | N/A | $43 |
| Blood Test - Cholesterol Test, Lipid Panel | $107 | N/A | $39 |
| Blood Test - Clotting Time | $38 | N/A | $14 |
| Blood Test - Coagulation Assessment | $145 | N/A | $52 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $92 | N/A | $33 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $72 | N/A | $26 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $57 | N/A | $20 |
| Blood Test - Creatinine Level | $96 | N/A | $34 |
| Blood Test - Electrolytes Panel | $99 | N/A | $36 |
| Blood Test - General Health Panel | $181 | N/A | $65 |
| Blood Test - Hepatic (Liver) Function Panel | $169 | N/A | $61 |
| Blood Test - Hepatitis B Surface Antibody Level | $72 | N/A | $26 |
| Blood Test - Hepatitis C Antibody Level | $124 | N/A | $45 |
| Blood Test - Iron Binding Capacity | $60 | N/A | $22 |
| Blood Test - Iron Level | $72 | N/A | $26 |
| Blood Test - LDL Cholesterol Level | $68 | N/A | $25 |
| Blood Test - Lead Level | $77 | N/A | $28 |
| Blood Test - Magnesium Level | $124 | N/A | $45 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $184 | N/A | $66 |
| Blood Test - Renal (Kidney) Function Panel | $251 | N/A | $90 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $130 | N/A | $47 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $158 | N/A | $57 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $85 | N/A | $31 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $159 | N/A | $57 |
| Blood Test - Vitamin D-3 Level | $237 | N/A | $85 |
| Bone Density Scan (outpatient) | $709 | N/A | $255 |
| Colonoscopy - Diagnostic (outpatient) | $6,877 | N/A | $2,476 |
| Colonoscopy - With Biopsy (outpatient) | $8,513 | N/A | $3,065 |
| Colonoscopy - With Polyp Removal (outpatient) | $9,325 | N/A | $3,357 |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,568 | N/A | $1,645 |
| CT Scan - Chest, with Contrast (outpatient) | $3,185 | N/A | $1,147 |
| CT Scan - Head/Brain, without Contrast | $1,640 | N/A | $590 |
| Cystoscopy | $1,305 | N/A | $470 |
| Emergency Department Visit - Low Complexity (outpatient) | $401 | N/A | $144 |
| Emergency Department Visit - Minor (outpatient) | $232 | N/A | $84 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $699 | N/A | $252 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $99 | N/A | $36 |
| Fetal Non-Stress Test | $943 | N/A | $340 |
| Gall Bladder Surgery (outpatient) | $18,965 | N/A | $6,827 |
| Hernia Repair - Laparoscopic (outpatient) | $17,339 | N/A | $6,242 |
| Hydration Infusion | $82 | N/A | $29 |
| Lab Test - Creatinine Level | $120 | N/A | $43 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $107 | N/A | $39 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $65 | N/A | $23 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $244 | N/A | $88 |
| Lab Test - Smear for Microorganism | $65 | N/A | $23 |
| Mammogram (outpatient) | $1,085 | N/A | $390 |
| MRI - Back (outpatient) | $4,101 | N/A | $1,476 |
| MRI - Brain (outpatient) | $8,068 | N/A | $2,905 |
| MRI - Knee (outpatient) | $2,783 | N/A | $1,002 |
| MRI - Pelvis (outpatient) | $5,584 | N/A | $2,010 |
| MRI - Shoulder, Elbow, or Wrist | $2,783 | N/A | $1,002 |
| Myocardial Imaging (outpatient) | $10,799 | N/A | $3,888 |
| Pap Test, automated screening and manual rescreening | $196 | N/A | $71 |
| Pap Test, manual screening | $129 | N/A | $46 |
| Physical Therapy - High Complexity Evaluation | $564 | 
Near Average
State Average: 1 | $203 |
| Physical Therapy - Manual Therapy | $147 | 
Below Average
State Average: 4 | $53 |
| Physical Therapy - Self-care or Home Management Training | $147 | 
Above Average
State Average: 1 | $53 |
| Physical Therapy - Therapeutic Activities | $147 |
Below Average
State Average: 3 | $53 |
| Physical Therapy - Therapeutic Exercises | $147 |
Below Average
State Average: 4 | $53 |
| Physical Therapy - Walking Training, 15 minutes | $147 |
Above Average
State Average: 1 | $53 |
| Psychotherapy - 30 Minutes | $89 |
Above Average
State Average: 1 | $32 |
| Psychotherapy - Group Session | $107 |
Above Average
State Average: 5 | $39 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $65 | N/A | $23 |
| Ultrasound - Abdominal, Complete | $1,235 | N/A | $445 |
| Ultrasound - Abdominal, Limited | $992 | N/A | $357 |
| Ultrasound - Breast (outpatient) | $476 | N/A | $171 |
| Ultrasound - Head and Neck | $993 | N/A | $358 |
| Ultrasound - Transvaginal (non-maternity) | $1,000 | N/A | $360 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $6,648 | N/A | $2,393 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $8,150 | N/A | $2,934 |
| Urine Capacity Measurement | $638 | N/A | $230 |
| Urine Test - Automated with Microscope Examination | $57 | N/A | $20 |
| Urine Test - Automated without Microscope | $27 | N/A | $10 |
| Urine Test - Chlamydia | $223 | N/A | $80 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $223 | N/A | $80 |
| Urine Test - Microalbumin (Protein) Level | $50 | N/A | $18 |
| Urine Test - Pregnancy | $123 | N/A | $44 |
| Vaccine - Influenza for Injection into Muscle | $62 | N/A | $22 |
| X-Ray - Abdomen | $639 | N/A | $230 |
| X-Ray - Ankle (outpatient) | $466 | N/A | $168 |
| X-Ray - Chest (outpatient) | $674 | N/A | $243 |
| X-Ray - Foot (outpatient) | $668 | N/A | $240 |
| X-Ray - Hand | $696 | N/A | $251 |
| X-Ray - Hip | $743 | N/A | $268 |
| X-Ray - Knee (outpatient) | $760 | N/A | $274 |
| X-Ray - Middle Back, Thoracic Spine | $702 | N/A | $253 |
| X-Ray - Neck, Cervical Spine | $639 | N/A | $230 |
| X-Ray - Shoulder (outpatient) | $684 | N/A | $246 |
| X-Ray - Spine (outpatient) | $738 | N/A | $266 |
| X-Ray - Wrist (outpatient) | $353 | N/A | $127 |
