| Arthrocentesis (outpatient) | $866 | N/A | $866 |
| Bacterial Culture - Swab | $194 | N/A | $194 |
| Biopsy - Tangential Biopsy of Skin | $1,152 | N/A | $1,152 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $102 | N/A | $102 |
| Blood Test - Blood Typing (ABO) | $82 | N/A | $82 |
| Blood Test - Blood Typing (Rh (D)) | $113 | N/A | $113 |
| Blood Test - Cholesterol Test, Lipid Panel | $123 | N/A | $123 |
| Blood Test - Clotting Time | $53 | N/A | $53 |
| Blood Test - Coagulation Assessment | $54 | N/A | $54 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $70 | N/A | $70 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $59 | N/A | $59 |
| Blood Test - Comprehensive Metabolic Panel | $65 | N/A | $65 |
| Blood Test - Ferritin (Blood Protein) Level | $83 | N/A | $83 |
| Blood Test - General Health Panel | $204 | N/A | $204 |
| Blood Test - Hepatic (Liver) Function Panel | $56 | N/A | $56 |
| Blood Test - Hepatitis C Antibody Level | $152 | N/A | $152 |
| Blood Test - Iron Level | $41 | N/A | $41 |
| Blood Test - LDL Cholesterol Level | $76 | N/A | $76 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $113 | N/A | $113 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $104 | N/A | $104 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $56 | N/A | $56 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $97 | N/A | $97 |
| Blood Test - Vitamin D-3 Level | $184 | N/A | $184 |
| Bone Density Scan (outpatient) | $709 | N/A | $709 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,750 | N/A | $2,750 |
| Destruction of Lesion (outpatient) | $621 | N/A | $621 |
| Destruction of Lesions, up to 14 | $413 | N/A | $413 |
| Developmental Screening | $70 | N/A | $70 |
| Electrocardiogram (ECG or EKG), Tracing | $630 | N/A | $630 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $551 | N/A | $551 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $108 | N/A | $108 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $105 | N/A | $105 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $197 | N/A | $197 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $149 | N/A | $149 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $195 | N/A | $195 |
| Lab Test - Detection test for Influenza Virus | $75 | N/A | $75 |
| Mammogram (outpatient) | $547 | N/A | $547 |
| MRI - Back (outpatient) | $3,539 | N/A | $3,539 |
| MRI - Brain (outpatient) | $7,245 | N/A | $7,245 |
| MRI - Knee (outpatient) | $3,288 | N/A | $3,288 |
| Office Visit - Basic | $168 | N/A | $168 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $406 | N/A | $406 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $480 | N/A | $480 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $480 | N/A | $480 |
| 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 | $427 | N/A | $427 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $385 | N/A | $385 |
| 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 | $246 | N/A | $246 |
| Psychotherapy - 30 Minutes | $169 | 
Near Average
State Average: 1 | $169 |
| Ultrasound - Breast (outpatient) | $864 | N/A | $864 |
| Ultrasound - Pelvic (outpatient) | $595 | N/A | $595 |
| Ultrasound - Pregnancy (outpatient) | $744 | N/A | $744 |
| Ultrasound - Pregnancy Follow-Up | $510 | N/A | $510 |
| Ultrasound - Transvaginal (non-maternity) | $1,006 | N/A | $1,006 |
| Urine Test - Automated with Microscope Examination | $175 | N/A | $175 |
| Urine Test - Automated without Microscope | $53 | N/A | $53 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $90 | N/A | $90 |
| Urine Test - Chlamydia | $180 | N/A | $180 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $164 | N/A | $164 |
| Urine Test - Microalbumin (Protein) Level | $69 | N/A | $69 |
| Urine Test - Pregnancy | $62 | N/A | $62 |
| 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 | $144 | N/A | $144 |
| X-Ray - Chest (outpatient) | $606 | N/A | $606 |
| X-Ray - Foot (outpatient) | $576 | N/A | $576 |
| X-Ray - Hand | $818 | N/A | $818 |
| X-Ray - Knee (outpatient) | $583 | N/A | $583 |
| X-Ray - Shoulder (outpatient) | $680 | N/A | $680 |
