| Arthrocentesis (outpatient) | $435 | N/A | $435 |
| Bacterial Culture - Aerobic Isolates | $20 | N/A | $20 |
| Bacterial Culture - Swab | $21 | N/A | $21 |
| Blood Test - Basic Metabolic Panel | $28 | N/A | $28 |
| Blood Test - Blood Glucose (Sugar) Level | $13 | N/A | $13 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $33 | N/A | $33 |
| Blood Test - C-reactive Protein (CRP) Level | $18 | N/A | $18 |
| Blood Test - Cholesterol Test, Lipid Panel | $60 | N/A | $60 |
| Blood Test - Clotting Time | $13 | N/A | $13 |
| Blood Test - Coagulation Assessment | $15 | N/A | $15 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $22 | N/A | $22 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $26 | N/A | $26 |
| Blood Test - Comprehensive Metabolic Panel | $35 | N/A | $35 |
| Blood Test - Creatinine Level | $18 | N/A | $18 |
| Blood Test - Electrolytes Panel | $23 | N/A | $23 |
| Blood Test - Ferritin (Blood Protein) Level | $45 | N/A | $45 |
| Blood Test - Folic Acid Level | $49 | N/A | $49 |
| Blood Test - General Health Panel | $104 | N/A | $104 |
| Blood Test - Hepatic (Liver) Function Panel | $27 | N/A | $27 |
| Blood Test - Hepatitis B Surface Antibody Level | $26 | N/A | $26 |
| Blood Test - Hepatitis C Antibody Level | $35 | N/A | $35 |
| Blood Test - Iron Binding Capacity | $29 | N/A | $29 |
| Blood Test - Iron Level | $22 | N/A | $22 |
| Blood Test - LDL Cholesterol Level | $56 | N/A | $56 |
| Blood Test - Lead Level | $40 | N/A | $40 |
| Blood Test - Lipase (fat enzyme) Level | $17 | N/A | $17 |
| Blood Test - Magnesium Level | $23 | N/A | $23 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $61 | N/A | $61 |
| Blood Test - Renal (Kidney) Function Panel | $33 | N/A | $33 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $39 | N/A | $39 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $56 | N/A | $56 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $29 | N/A | $29 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $61 | N/A | $61 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $49 | N/A | $49 |
| Blood Test - Vitamin D-3 Level | $99 | N/A | $99 |
| Destruction of Lesion (outpatient) | $497 | N/A | $497 |
| Developmental Screening | $33 | N/A | $33 |
| Electrocardiogram (ECG or EKG), Tracing | $642 | N/A | $642 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $342 | N/A | $342 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $21 | N/A | $21 |
| Lab Test - Creatinine Level | $17 | N/A | $17 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $40 | N/A | $40 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $106 | N/A | $106 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $25 | N/A | $25 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $25 | N/A | $25 |
| Lab Test - Detection test for Influenza Virus | $40 | N/A | $40 |
| Laryngoscopy - Diagnostic | $623 | N/A | $623 |
| Mammogram (outpatient) | $942 | N/A | $942 |
| Nasal Endoscopy - Diagnostic | $802 | N/A | $802 |
| Office Visit - Basic | $109 | N/A | $109 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $279 | N/A | $279 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $330 | N/A | $330 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $318 | N/A | $318 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $370 | N/A | $370 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $291 | N/A | $291 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $267 | N/A | $267 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $261 | N/A | $261 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $287 | N/A | $287 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $292 | N/A | $292 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $312 | N/A | $312 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $260 | N/A | $260 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $245 | N/A | $245 |
| Office Visit - Established Patient, High Complexity | $361 | N/A | $361 |
| Office Visit - Established Patient, Low Complexity | $172 | N/A | $172 |
| Office Visit - Established Patient, Moderate Complexity | $268 | N/A | $268 |
| Office Visit - New Patient, Low Complexity | $270 | N/A | $270 |
| Office Visit - New Patient, Minor | $186 | N/A | $186 |
| Office Visit - New Patient, Moderate Complexity | $408 | N/A | $408 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 
Near Average
State Average: 3 | $53 |
| Physical Therapy - Application of Mechanical Traction | $53 | 
Below Average
State Average: 3 | $53 |
| Physical Therapy - Electrical Stimulation Therapy | $53 |
Near Average
State Average: 3 | $53 |
| Physical Therapy - High Complexity Evaluation | $158 |
Near Average
State Average: 1 | $158 |
| Physical Therapy - Low Complexity Evaluation | $234 |
Near Average
State Average: 1 | $234 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $47 | 
Above Average
State Average: 3 | $47 |
| Physical Therapy - Manual Therapy | $74 |
Near Average
State Average: 4 | $74 |
| Physical Therapy - Moderate Complexity Evaluation | $210 |
Near Average
State Average: 1 | $210 |
| Physical Therapy - Neuromuscular Reeducation | $79 |
Below Average
State Average: 4 | $79 |
| Physical Therapy - Re-Evaluation | $95 |
Near Average
State Average: 1 | $95 |
| Physical Therapy - Self-care or Home Management Training | $95 |
Near Average
State Average: 1 | $95 |
| Physical Therapy - Therapeutic Activities | $111 |
Near Average
State Average: 3 | $111 |
| Physical Therapy - Therapeutic Exercises | $85 |
Below Average
State Average: 4 | $85 |
| Physical Therapy - Ultrasound Therapy | $38 |
Below Average
State Average: 3 | $38 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $22 | N/A | $22 |
| Urine Capacity Measurement | $403 | N/A | $403 |
| Urine Test - Automated with Microscope Examination | $11 | N/A | $11 |
| Urine Test - Automated without Microscope | $7 | N/A | $7 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $26 | N/A | $26 |
| Urine Test - Chlamydia | $117 | N/A | $117 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $117 | N/A | $117 |
| Urine Test - Microalbumin (Protein) Level | $19 | N/A | $19 |
| Urine Test - Pregnancy | $21 | N/A | $21 |
| Urine Test - Urinalysis, Manual Test | $8 | N/A | $8 |
| Vaccine - Influenza for Injection into Muscle | $37 | N/A | $37 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $396 | N/A | $396 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $78 | N/A | $78 |
| X-Ray - Ankle (outpatient) | $299 | N/A | $299 |
| X-Ray - Foot (outpatient) | $317 | N/A | $317 |
| X-Ray - Hand | $467 | N/A | $467 |
| X-Ray - Hip | $305 | N/A | $305 |
| X-Ray - Knee (outpatient) | $353 | N/A | $353 |
| X-Ray - Pelvis | $316 | N/A | $316 |
| X-Ray - Shoulder (outpatient) | $387 | N/A | $387 |
| X-Ray - Spine (outpatient) | $424 | N/A | $424 |
| X-Ray - Wrist (outpatient) | $314 | N/A | $314 |
