| Arthrocentesis (outpatient) | $518 | N/A | $518 |
| Bacterial Culture - Swab | $191 | N/A | $191 |
| Biopsy - Punch Biopsy of Skin | $1,555 | N/A | $1,555 |
| Biopsy - Tangential Biopsy of Skin | $1,458 | N/A | $1,458 |
| Blood Test - Basic Metabolic Panel | $161 | N/A | $161 |
| Blood Test - Blood Glucose (Sugar) Level | $43 | N/A | $43 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $106 | N/A | $106 |
| Blood Test - Blood Typing (ABO) | $82 | N/A | $82 |
| Blood Test - Blood Typing (Rh (D)) | $113 | N/A | $113 |
| Blood Test - C-reactive Protein (CRP) Level | $107 | N/A | $107 |
| Blood Test - Cholesterol Test, Lipid Panel | $154 | N/A | $154 |
| Blood Test - Clotting Time | $13 | N/A | $13 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $70 | N/A | $70 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $80 | N/A | $80 |
| Blood Test - Comprehensive Metabolic Panel | $213 | N/A | $213 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $57 | N/A | $57 |
| Blood Test - Ferritin (Blood Protein) Level | $153 | N/A | $153 |
| Blood Test - Folic Acid Level | $125 | N/A | $125 |
| Blood Test - General Health Panel | $208 | N/A | $208 |
| Blood Test - Hepatitis C Antibody Level | $138 | N/A | $138 |
| Blood Test - Iron Binding Capacity | $93 | N/A | $93 |
| Blood Test - Iron Level | $58 | N/A | $58 |
| Blood Test - Magnesium Level | $95 | N/A | $95 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $122 | N/A | $122 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $99 | N/A | $99 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $149 | N/A | $149 |
| Blood Test - Vitamin D-3 Level | $208 | N/A | $208 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,711 | N/A | $3,711 |
| Destruction of Lesion (outpatient) | $589 | N/A | $589 |
| Destruction of Lesions, up to 14 | $681 | N/A | $681 |
| Developmental Screening | $70 | N/A | $70 |
| Electrocardiogram (ECG or EKG), Tracing | $930 | N/A | $930 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $653 | N/A | $653 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $186 | N/A | $186 |
| Lab Test - Creatinine Level | $49 | N/A | $49 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $107 | N/A | $107 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $197 | N/A | $197 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $132 | N/A | $132 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $349 | N/A | $349 |
| Lab Test - Detection test for Influenza Virus | $88 | N/A | $88 |
| Lab Test - Smear for Microorganism | $111 | N/A | $111 |
| Laryngoscopy - Diagnostic | $1,300 | N/A | $1,300 |
| Mammogram (outpatient) | $947 | N/A | $947 |
| MRI - Knee (outpatient) | $3,581 | N/A | $3,581 |
| MRI - Pelvis (outpatient) | $6,277 | N/A | $6,277 |
| Nasal Endoscopy - Diagnostic | $1,290 | N/A | $1,290 |
| Office Visit - Basic | $104 | N/A | $104 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $254 | N/A | $254 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $357 | N/A | $357 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $442 | N/A | $442 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $361 | N/A | $361 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $237 | N/A | $237 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $372 | N/A | $372 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $256 | N/A | $256 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | N/A | $247 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $387 | N/A | $387 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $422 | N/A | $422 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $324 | N/A | $324 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $196 | N/A | $196 |
| Office Visit - Established Patient, High Complexity | $501 | N/A | $501 |
| Office Visit - Established Patient, Low Complexity | $160 | N/A | $160 |
| Office Visit - Established Patient, Moderate Complexity | $278 | N/A | $278 |
| Office Visit - New Patient, Low Complexity | $236 | N/A | $236 |
| Office Visit - New Patient, Minor | $264 | N/A | $264 |
| Office Visit - New Patient, Moderate Complexity | $359 | N/A | $359 |
| Pap Test, automated screening and manual rescreening | $227 | N/A | $227 |
| Pap Test, manual screening | $163 | N/A | $163 |
| Physical Therapy - Moderate Complexity Evaluation | $342 | 
Near Average
State Average: 1 | $342 |
| Physical Therapy - Therapeutic Exercises | $138 | 
Below Average
State Average: 4 | $138 |
| Psychotherapy - 30 Minutes | $167 |
Near Average
State Average: 1 | $167 |
| Psychotherapy - Group Session | $134 |
Near Average
State Average: 5 | $134 |
| Ultrasound - Breast (outpatient) | $596 | N/A | $596 |
| Urine Capacity Measurement | $507 | N/A | $507 |
| Urine Test - Automated with Microscope Examination | $40 | N/A | $40 |
| Urine Test - Automated without Microscope | $60 | N/A | $60 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $113 | N/A | $113 |
| Urine Test - Chlamydia | $226 | N/A | $226 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $244 | N/A | $244 |
| Urine Test - Microalbumin (Protein) Level | $89 | N/A | $89 |
| Urine Test - Pregnancy | $62 | N/A | $62 |
| Urine Test - Urinalysis, Manual Test | $19 | N/A | $19 |
| Vaccine - Influenza for Injection into Muscle | $62 | N/A | $62 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $654 | N/A | $654 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $144 | N/A | $144 |
| X-Ray - Chest (outpatient) | $597 | N/A | $597 |
| X-Ray - Hip | $886 | N/A | $886 |
| X-Ray - Shoulder (outpatient) | $930 | N/A | $930 |
