| Arthrocentesis (outpatient) | $1,606 | N/A | $723 |
| Bacterial Culture - Aerobic Isolates | $102 | N/A | $46 |
| Bacterial Culture - Swab | $125 | N/A | $56 |
| Biopsy - Breast | $9,881 | N/A | $4,446 |
| Biopsy - Endometrial (Uterus) | $1,058 | N/A | $476 |
| Biopsy - Punch Biopsy of Skin | $1,588 | N/A | $715 |
| Biopsy - Tangential Biopsy of Skin | $1,227 | N/A | $552 |
| Blood Test - Basic Metabolic Panel | $93 | N/A | $42 |
| Blood Test - Blood Glucose (Sugar) Level | $45 | N/A | $20 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $91 | N/A | $41 |
| Blood Test - Blood Typing (ABO) | $47 | N/A | $21 |
| Blood Test - Blood Typing (Rh (D)) | $58 | N/A | $26 |
| Blood Test - C-reactive Protein (CRP) Level | $117 | N/A | $52 |
| Blood Test - Cholesterol Test, Lipid Panel | $147 | N/A | $66 |
| Blood Test - Clotting Time | $67 | N/A | $30 |
| Blood Test - Coagulation Assessment | $93 | N/A | $42 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $63 | N/A | $28 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $95 | N/A | $43 |
| Blood Test - Comprehensive Metabolic Panel | $107 | N/A | $48 |
| Blood Test - Creatinine Level | $46 | N/A | $21 |
| Blood Test - Electrolytes Panel | $106 | N/A | $48 |
| Blood Test - Ferritin (Blood Protein) Level | $158 | N/A | $71 |
| Blood Test - Folic Acid Level | $152 | N/A | $69 |
| Blood Test - General Health Panel | $354 | N/A | $159 |
| Blood Test - Hepatic (Liver) Function Panel | $113 | N/A | $51 |
| Blood Test - Hepatitis B Surface Antibody Level | $126 | N/A | $57 |
| Blood Test - Hepatitis C Antibody Level | $177 | N/A | $80 |
| Blood Test - Iron Binding Capacity | $106 | N/A | $48 |
| Blood Test - Iron Level | $76 | N/A | $34 |
| Blood Test - LDL Cholesterol Level | $101 | N/A | $45 |
| Blood Test - Lead Level | $131 | N/A | $59 |
| Blood Test - Lipase (fat enzyme) Level | $95 | N/A | $43 |
| Blood Test - Magnesium Level | $93 | N/A | $42 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $176 | N/A | $79 |
| Blood Test - Renal (Kidney) Function Panel | $88 | N/A | $40 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $228 | N/A | $103 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $152 | N/A | $69 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $105 | N/A | $47 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $180 | N/A | $81 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $180 | N/A | $81 |
| Blood Test - Vitamin D-3 Level | $289 | N/A | $130 |
| Bone Density Scan (outpatient) | $886 | N/A | $399 |
| Colonoscopy - Diagnostic (outpatient) | $5,798 | N/A | $2,609 |
| Colonoscopy - With Biopsy (outpatient) | $7,452 | N/A | $3,353 |
| Colonoscopy - With Polyp Removal (outpatient) | $8,232 | N/A | $3,704 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,040 | N/A | $2,268 |
| CT Scan - Chest, with Contrast (outpatient) | $2,979 | N/A | $1,340 |
| CT Scan - Head/Brain, without Contrast | $2,240 | N/A | $1,008 |
| Cystoscopy | $1,079 | N/A | $486 |
| Emergency Department Visit - Low Complexity (outpatient) | $487 | N/A | $219 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $873 | N/A | $393 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $129 | N/A | $58 |
| Fetal Non-Stress Test | $998 | N/A | $449 |
| Gall Bladder Surgery (outpatient) | $20,419 | N/A | $9,188 |
| Hernia Repair - Laparoscopic (outpatient) | $18,958 | N/A | $8,531 |
| Hydration Infusion | $166 | N/A | $75 |
| Kidney Stone Removal (outpatient) | $15,465 | N/A | $6,959 |
| Lab Test - Creatinine Level | $64 | N/A | $29 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $101 | N/A | $45 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $205 | N/A | $92 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $131 | N/A | $59 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $146 | N/A | $66 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $215 | N/A | $97 |
| Lab Test - Detection test for Influenza Virus | $135 | N/A | $61 |
| Lab Test - Smear for Microorganism | $63 | N/A | $28 |
| Mammogram (outpatient) | $1,198 | N/A | $539 |
| MRI - Back (outpatient) | $4,109 | N/A | $1,849 |
| MRI - Brain (outpatient) | $6,032 | N/A | $2,714 |
| MRI - Knee (outpatient) | $4,059 | N/A | $1,827 |
| MRI - Pelvis (outpatient) | $5,593 | N/A | $2,517 |
| MRI - Shoulder, Elbow, or Wrist | $3,835 | N/A | $1,726 |
| Myocardial Imaging (outpatient) | $7,333 | N/A | $3,300 |
| Office Visit - Basic | $92 | N/A | $42 |
| Office Visit - Established Patient, High Complexity | $307 | N/A | $138 |
| Office Visit - Established Patient, Low Complexity | $154 | N/A | $69 |
| Office Visit - Established Patient, Moderate Complexity | $228 | N/A | $103 |
| Office Visit - New Patient, Low Complexity | $228 | N/A | $103 |
| Office Visit - New Patient, Minor | $159 | N/A | $71 |
| Office Visit - New Patient, Moderate Complexity | $349 | N/A | $157 |
| Pap Test, automated screening and manual rescreening | $202 | N/A | $91 |
| Pap Test, manual screening | $194 | N/A | $87 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $117 | 
Above Average
State Average: 3 | $52 |
| Physical Therapy - Application of Hot or Cold Pack | $32 | 
Below Average
State Average: 3 | $14 |
| Physical Therapy - High Complexity Evaluation | $296 | 
Near Average
State Average: 1 | $133 |
| Physical Therapy - Low Complexity Evaluation | $243 |
Near Average
State Average: 1 | $109 |
| Physical Therapy - Manual Therapy | $162 |
Below Average
State Average: 4 | $73 |
| Physical Therapy - Moderate Complexity Evaluation | $270 |
Near Average
State Average: 1 | $121 |
| Physical Therapy - Ultrasound Therapy | $101 |
Near Average
State Average: 3 | $45 |
| Physical Therapy - Walking Training, 15 minutes | $161 |
Near Average
State Average: 1 | $72 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $93 | N/A | $42 |
| Tonsillectomy with Adenoidectomy (outpatient) | $16,927 | N/A | $7,617 |
| Ultrasound - Abdominal, Complete | $1,586 | N/A | $713 |
| Ultrasound - Abdominal, Limited | $1,198 | N/A | $539 |
| Ultrasound - Breast (outpatient) | $2,136 | N/A | $961 |
| Ultrasound - Head and Neck | $1,040 | N/A | $468 |
| Ultrasound - Pelvic (outpatient) | $1,151 | N/A | $518 |
| Ultrasound - Pregnancy (outpatient) | $1,483 | N/A | $667 |
| Ultrasound - Pregnancy Follow-Up | $1,153 | N/A | $519 |
| Ultrasound - Transvaginal (non-maternity) | $961 | N/A | $432 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $5,733 | N/A | $2,580 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $8,174 | N/A | $3,678 |
| Urine Capacity Measurement | $581 | N/A | $261 |
| Urine Test - Automated with Microscope Examination | $71 | N/A | $32 |
| Urine Test - Automated without Microscope | $40 | N/A | $18 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $89 | N/A | $40 |
| Urine Test - Chlamydia | $261 | N/A | $118 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $261 | N/A | $118 |
| Urine Test - Microalbumin (Protein) Level | $102 | N/A | $46 |
| Urine Test - Pregnancy | $59 | N/A | $26 |
| Vaccine - Influenza for Injection into Muscle | $47 | N/A | $21 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $460 | N/A | $207 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $114 | N/A | $51 |
| X-Ray - Abdomen | $678 | N/A | $305 |
| X-Ray - Ankle (outpatient) | $677 | N/A | $305 |
| X-Ray - Chest (outpatient) | $927 | N/A | $417 |
| X-Ray - Foot (outpatient) | $941 | N/A | $423 |
| X-Ray - Hand | $916 | N/A | $412 |
| X-Ray - Hip | $764 | N/A | $344 |
| X-Ray - Knee (outpatient) | $822 | N/A | $370 |
| X-Ray - Middle Back, Thoracic Spine | $952 | N/A | $429 |
| X-Ray - Neck, Cervical Spine | $774 | N/A | $348 |
| X-Ray - Pelvis | $617 | N/A | $278 |
| X-Ray - Shoulder (outpatient) | $798 | N/A | $359 |
| X-Ray - Spine (outpatient) | $881 | N/A | $396 |
| X-Ray - Wrist (outpatient) | $916 | N/A | $412 |
