| Arthrocentesis (outpatient) | $838 | N/A | $838 |
| Bacterial Culture - Aerobic Isolates | $88 | N/A | $88 |
| Biopsy - Punch Biopsy of Skin | $1,782 | N/A | $1,782 |
| Biopsy - Tangential Biopsy of Skin | $1,423 | N/A | $1,423 |
| Blood Test - Basic Metabolic Panel | $68 | N/A | $68 |
| Blood Test - Blood Glucose (Sugar) Level | $49 | N/A | $49 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $22 | N/A | $22 |
| Blood Test - C-reactive Protein (CRP) Level | $77 | N/A | $77 |
| Blood Test - Cholesterol Test, Lipid Panel | $108 | N/A | $108 |
| Blood Test - Clotting Time | $53 | N/A | $53 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $78 | N/A | $78 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $29 | N/A | $29 |
| Blood Test - Comprehensive Metabolic Panel | $89 | N/A | $89 |
| Blood Test - Hepatic (Liver) Function Panel | $74 | N/A | $74 |
| Blood Test - Hepatitis C Antibody Level | $124 | N/A | $124 |
| Blood Test - Iron Binding Capacity | $57 | N/A | $57 |
| Blood Test - Iron Level | $69 | N/A | $69 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $184 | N/A | $184 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $151 | N/A | $151 |
| Blood Test - Vitamin D-3 Level | $265 | N/A | $265 |
| Bone Density Scan (outpatient) | $709 | N/A | $709 |
| Destruction of Lesion (outpatient) | $612 | N/A | $612 |
| Destruction of Lesions, up to 14 | $701 | N/A | $701 |
| Developmental Screening | $70 | N/A | $70 |
| Electrocardiogram (ECG or EKG), Tracing | $717 | N/A | $717 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $529 | N/A | $529 |
| Lab Test - Creatinine Level | $117 | N/A | $117 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $69 | N/A | $69 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $244 | N/A | $244 |
| Lab Test - Detection test for Influenza Virus | $75 | N/A | $75 |
| Laryngoscopy - Diagnostic | $1,179 | N/A | $1,179 |
| Mammogram (outpatient) | $1,085 | N/A | $1,085 |
| Nasal Endoscopy - Diagnostic | $1,232 | N/A | $1,232 |
| Office Visit - Basic | $168 | N/A | $168 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $280 | N/A | $280 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $337 | N/A | $337 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $461 | N/A | $461 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $545 | N/A | $545 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $408 | N/A | $408 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $322 | N/A | $322 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $324 | N/A | $324 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $387 | N/A | $387 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $422 | N/A | $422 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $461 | N/A | $461 |
| 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 | $302 | N/A | $302 |
| Office Visit - Established Patient, High Complexity | $512 | N/A | $512 |
| Office Visit - Established Patient, Low Complexity | $235 | N/A | $235 |
| Office Visit - Established Patient, Moderate Complexity | $358 | N/A | $358 |
| Office Visit - New Patient, Low Complexity | $360 | N/A | $360 |
| Office Visit - New Patient, Minor | $273 | N/A | $273 |
| Office Visit - New Patient, Moderate Complexity | $544 | N/A | $544 |
| Pap Test, automated screening and manual rescreening | $166 | N/A | $166 |
| Physical Therapy - Electrical Stimulation Therapy | $39 | 
Above Average
State Average: 3 | $39 |
| Physical Therapy - Low Complexity Evaluation | $127 | 
Near Average
State Average: 1 | $127 |
| Physical Therapy - Manual Therapy | $39 | 
Below Average
State Average: 4 | $39 |
| Physical Therapy - Therapeutic Exercises | $39 |
Below Average
State Average: 4 | $39 |
| Psychiatric Diagnostic Evaluation | $195 |
Near Average
State Average: 1 | $195 |
| Psychotherapy - 30 Minutes | $75 |
Near Average
State Average: 1 | $75 |
| Psychotherapy - 45 Minutes | $120 |
Below Average
State Average: 4 | $120 |
| Psychotherapy - Group Session | $65 |
Near Average
State Average: 5 | $65 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | N/A | $12 |
| Ultrasound - Pregnancy (outpatient) | $744 | N/A | $744 |
| Ultrasound - Transvaginal (non-maternity) | $1,418 | N/A | $1,418 |
| Urine Test - Automated with Microscope Examination | $55 | N/A | $55 |
| Urine Test - Automated without Microscope | $53 | N/A | $53 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $50 | N/A | $50 |
| Urine Test - Chlamydia | $218 | N/A | $218 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $218 | N/A | $218 |
| Urine Test - Microalbumin (Protein) Level | $50 | N/A | $50 |
| Urine Test - Pregnancy | $59 | N/A | $59 |
| Urine Test - Urinalysis, Manual Test | $57 | N/A | $57 |
| 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 | $141 | N/A | $141 |
| X-Ray - Foot (outpatient) | $817 | N/A | $817 |
| X-Ray - Hand | $1,129 | N/A | $1,129 |
| X-Ray - Knee (outpatient) | $842 | N/A | $842 |
| X-Ray - Shoulder (outpatient) | $908 | N/A | $908 |
| X-Ray - Spine (outpatient) | $898 | N/A | $898 |
| X-Ray - Wrist (outpatient) | $883 | N/A | $883 |
