| Arthrocentesis (outpatient) | $1,170 | N/A | $421 |
| Bacterial Culture - Aerobic Isolates | $89 | N/A | $32 |
| Bacterial Culture - Swab | $148 | N/A | $53 |
| Biopsy - Breast | $3,951 | N/A | $1,422 |
| Biopsy - Endometrial (Uterus) | $1,535 | N/A | $553 |
| Biopsy - Punch Biopsy of Skin | $1,121 | N/A | $404 |
| Biopsy - Tangential Biopsy of Skin | $1,054 | N/A | $380 |
| Blood Test - Basic Metabolic Panel | $102 | N/A | $37 |
| Blood Test - Blood Glucose (Sugar) Level | $68 | N/A | $25 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $112 | N/A | $40 |
| Blood Test - Blood Typing (ABO) | $65 | N/A | $23 |
| Blood Test - Blood Typing (Rh (D)) | $78 | N/A | $28 |
| Blood Test - C-reactive Protein (CRP) Level | $84 | N/A | $30 |
| Blood Test - Cholesterol Test, Lipid Panel | $128 | N/A | $46 |
| Blood Test - Clotting Time | $71 | N/A | $26 |
| Blood Test - Coagulation Assessment | $107 | N/A | $39 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $79 | N/A | $28 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $102 | N/A | $37 |
| Blood Test - Comprehensive Metabolic Panel | $122 | N/A | $44 |
| Blood Test - Creatinine Level | $78 | N/A | $28 |
| Blood Test - Electrolytes Panel | $128 | N/A | $46 |
| Blood Test - Ferritin (Blood Protein) Level | $188 | N/A | $68 |
| Blood Test - Folic Acid Level | $179 | N/A | $64 |
| Blood Test - General Health Panel | $376 | N/A | $135 |
| Blood Test - Hepatic (Liver) Function Panel | $100 | N/A | $36 |
| Blood Test - Hepatitis B Surface Antibody Level | $384 | N/A | $138 |
| Blood Test - Hepatitis C Antibody Level | $256 | N/A | $92 |
| Blood Test - Iron Binding Capacity | $82 | N/A | $29 |
| Blood Test - Iron Level | $66 | N/A | $24 |
| Blood Test - LDL Cholesterol Level | $83 | N/A | $30 |
| Blood Test - Lead Level | $50 | N/A | $18 |
| Blood Test - Lipase (fat enzyme) Level | $124 | N/A | $45 |
| Blood Test - Magnesium Level | $116 | N/A | $42 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $179 | N/A | $64 |
| Blood Test - Renal (Kidney) Function Panel | $102 | N/A | $37 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $72 | N/A | $26 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $164 | N/A | $59 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $163 | N/A | $59 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $204 | N/A | $73 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $188 | N/A | $68 |
| Blood Test - Vitamin D-3 Level | $251 | N/A | $90 |
| Bone Density Scan (outpatient) | $416 | N/A | $150 |
| Chiropractic Manipulative Treatment - 1+ Non-Spinal Regions | $21 | 
Below Average
State Average: 4 | $8 |
| Chiropractic Manipulative Treatment - Spinal, 1-2 Regions | $42 | 
Near Average
State Average: 2 | $15 |
| Chiropractic Manipulative Treatment - Spinal, 3-4 Regions | $78 |
Near Average
State Average: 4 | $28 |
| Chiropractic Manipulative Treatment - Spinal, 5 Regions | $63 |
Below Average
State Average: 3 | $23 |
| Colonoscopy - Diagnostic (outpatient) | $5,323 | N/A | $1,916 |
| Colonoscopy - With Biopsy (outpatient) | $5,281 | N/A | $1,901 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,494 | N/A | $2,338 |
| CT Scan - Abdomen and Pelvis, with Contrast | $8,241 | N/A | $2,967 |
| CT Scan - Chest, with Contrast (outpatient) | $4,485 | N/A | $1,615 |
| CT Scan - Head/Brain, without Contrast | $3,074 | N/A | $1,107 |
| Cystoscopy | $1,845 | N/A | $664 |
| Destruction of Lesion (outpatient) | $544 | N/A | $196 |
| Destruction of Lesions, up to 14 | $584 | N/A | $210 |
| Developmental Screening | $21 | N/A | $8 |
| Electrocardiogram (ECG or EKG), Tracing | $670 | N/A | $241 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $694 | N/A | $250 |
| Emergency Department Visit - Low Complexity (outpatient) | $642 | N/A | $231 |
| Emergency Department Visit - Minor (outpatient) | $390 | N/A | $140 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $1,097 | N/A | $395 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $141 | N/A | $51 |
| Fetal Non-Stress Test | $1,073 | N/A | $386 |
| Gall Bladder Surgery (outpatient) | $22,947 | N/A | $8,261 |
| Hernia Repair - Laparoscopic (outpatient) | $19,556 | N/A | $7,040 |
| Hydration Infusion | $179 | N/A | $64 |
| Kidney Stone Removal (outpatient) | $21,234 | N/A | $7,644 |
| Lab Test - Creatinine Level | $88 | N/A | $32 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $77 | N/A | $28 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $182 | N/A | $65 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $226 | N/A | $81 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $108 | N/A | $39 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $156 | N/A | $56 |
| Lab Test - Detection test for Influenza Virus | $35 | N/A | $12 |
| Lab Test - Smear for Microorganism | $89 | N/A | $32 |
| Mammogram (outpatient) | $776 | N/A | $280 |
| MRI - Back (outpatient) | $2,423 | N/A | $872 |
| MRI - Brain (outpatient) | $7,069 | N/A | $2,545 |
| MRI - Knee (outpatient) | $2,157 | N/A | $777 |
| MRI - Pelvis (outpatient) | $7,149 | N/A | $2,574 |
| MRI - Shoulder, Elbow, or Wrist | $4,978 | N/A | $1,792 |
| Myocardial Imaging (outpatient) | $8,242 | N/A | $2,967 |
| Office Visit - Basic | $165 | N/A | $59 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $221 | N/A | $79 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $352 | N/A | $127 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $362 | N/A | $130 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $444 | N/A | $160 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $286 | N/A | $103 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $273 | N/A | $98 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $273 | N/A | $98 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $311 | N/A | $112 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $311 | N/A | $112 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $362 | N/A | $130 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $273 | N/A | $98 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $233 | N/A | $84 |
| Office Visit - Established Patient, High Complexity | $456 | N/A | $164 |
| Office Visit - Established Patient, Low Complexity | $225 | N/A | $81 |
| Office Visit - Established Patient, Moderate Complexity | $322 | N/A | $116 |
| Office Visit - New Patient, Low Complexity | $310 | N/A | $112 |
| Office Visit - New Patient, Minor | $263 | N/A | $95 |
| Office Visit - New Patient, Moderate Complexity | $539 | N/A | $194 |
| Pap Test, automated screening and manual rescreening | $171 | N/A | $62 |
| Physical Therapy - Application of Hot or Cold Pack | $28 |
Below Average
State Average: 3 | $10 |
| Physical Therapy - Application of Mechanical Traction | $47 |
Below Average
State Average: 3 | $17 |
| Physical Therapy - High Complexity Evaluation | $385 |
Near Average
State Average: 1 | $139 |
| Physical Therapy - Low Complexity Evaluation | $268 |
Near Average
State Average: 1 | $96 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $47 |
Near Average
State Average: 3 | $17 |
| Physical Therapy - Manual Therapy | $101 |
Below Average
State Average: 4 | $36 |
| Physical Therapy - Moderate Complexity Evaluation | $286 |
Near Average
State Average: 1 | $103 |
| Physical Therapy - Neuromuscular Reeducation | $53 |
Below Average
State Average: 4 | $19 |
| Physical Therapy - Re-Evaluation | $133 |
Near Average
State Average: 1 | $48 |
| Physical Therapy - Self-care or Home Management Training | $112 |
Near Average
State Average: 1 | $40 |
| Physical Therapy - Therapeutic Activities | $106 |
Below Average
State Average: 3 | $38 |
| Physical Therapy - Therapeutic Exercises | $101 |
Near Average
State Average: 4 | $36 |
| Physical Therapy - Therapeutic Massage | $23 | 
Above Average
State Average: 3 | $8 |
| Physical Therapy - Ultrasound Therapy | $101 |
Below Average
State Average: 3 | $36 |
| Physical Therapy - Walking Training, 15 minutes | $106 |
Near Average
State Average: 1 | $38 |
| Psychiatric Diagnostic Evaluation | $210 |
Near Average
State Average: 1 | $76 |
| Psychotherapy - 45 Minutes | $131 |
Below Average
State Average: 4 | $47 |
| Psychotherapy - 60 Minutes | $163 |
Above Average
State Average: 5 | $59 |
| Psychotherapy - Group Session | $183 |
Above Average
State Average: 5 | $66 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $107 | N/A | $39 |
| Ultrasound - Abdominal, Complete | $1,710 | N/A | $616 |
| Ultrasound - Abdominal, Limited | $1,239 | N/A | $446 |
| Ultrasound - Breast (outpatient) | $1,054 | N/A | $379 |
| Ultrasound - Head and Neck | $1,217 | N/A | $438 |
| Ultrasound - Pelvic (outpatient) | $835 | N/A | $301 |
| Ultrasound - Pregnancy (outpatient) | $352 | N/A | $127 |
| Ultrasound - Pregnancy Follow-Up | $457 | N/A | $165 |
| Ultrasound - Transvaginal (non-maternity) | $1,051 | N/A | $378 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $4,780 | N/A | $1,721 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,868 | N/A | $1,752 |
| Urine Capacity Measurement | $495 | N/A | $178 |
| Urine Test - Automated with Microscope Examination | $110 | N/A | $40 |
| Urine Test - Automated without Microscope | $32 | N/A | $11 |
| Urine Test - Bacterial Culture | $15 | N/A | $6 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $102 | N/A | $37 |
| Urine Test - Chlamydia | $192 | N/A | $69 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $192 | N/A | $69 |
| Urine Test - Microalbumin (Protein) Level | $122 | N/A | $44 |
| Urine Test - Pregnancy | $32 | N/A | $11 |
| Urine Test - Urinalysis, Manual Test | $8 | N/A | $3 |
| Vaccine - Influenza for Injection into Muscle | $67 | N/A | $24 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $293 | N/A | $106 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $83 | N/A | $30 |
| X-Ray - Abdomen | $838 | N/A | $302 |
| X-Ray - Ankle (outpatient) | $847 | N/A | $305 |
| X-Ray - Chest (outpatient) | $957 | N/A | $344 |
| X-Ray - Foot (outpatient) | $929 | N/A | $334 |
| X-Ray - Hand | $1,065 | N/A | $383 |
| X-Ray - Hip | $910 | N/A | $328 |
| X-Ray - Knee (outpatient) | $838 | N/A | $302 |
| X-Ray - Middle Back, Thoracic Spine | $713 | N/A | $257 |
| X-Ray - Neck, Cervical Spine | $938 | N/A | $338 |
| X-Ray - Shoulder (outpatient) | $901 | N/A | $325 |
| X-Ray - Spine (outpatient) | $919 | N/A | $331 |
| X-Ray - Wrist (outpatient) | $1,002 | N/A | $361 |
