| Arthrocentesis (outpatient) | $381 | N/A | $381 |
| Biopsy - Punch Biopsy of Skin | $901 | N/A | $901 |
| Biopsy - Tangential Biopsy of Skin | $771 | N/A | $771 |
| Blood Test - Basic Metabolic Panel | $92 | N/A | $92 |
| Blood Test - Blood Glucose (Sugar) Level | $42 | N/A | $42 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $35 | N/A | $35 |
| Blood Test - C-reactive Protein (CRP) Level | $84 | N/A | $84 |
| Blood Test - Cholesterol Test, Lipid Panel | $147 | N/A | $147 |
| Blood Test - Clotting Time | $15 | N/A | $15 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $44 | N/A | $44 |
| Blood Test - Comprehensive Metabolic Panel | $90 | N/A | $90 |
| Blood Test - Ferritin (Blood Protein) Level | $83 | N/A | $83 |
| Blood Test - Folic Acid Level | $152 | N/A | $152 |
| Blood Test - General Health Panel | $277 | N/A | $277 |
| Blood Test - Hepatic (Liver) Function Panel | $113 | N/A | $113 |
| Blood Test - Hepatitis C Antibody Level | $112 | N/A | $112 |
| Blood Test - Iron Binding Capacity | $73 | N/A | $73 |
| Blood Test - Iron Level | $52 | N/A | $52 |
| Blood Test - Lead Level | $40 | N/A | $40 |
| Blood Test - Magnesium Level | $67 | N/A | $67 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $117 | N/A | $117 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $109 | N/A | $109 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $154 | N/A | $154 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $145 | N/A | $145 |
| Blood Test - Vitamin D-3 Level | $287 | N/A | $287 |
| Destruction of Lesion (outpatient) | $430 | N/A | $430 |
| Destruction of Lesions, up to 14 | $444 | N/A | $444 |
| Developmental Screening | $28 | N/A | $28 |
| Electrocardiogram (ECG or EKG), Tracing | $631 | N/A | $631 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $276 | N/A | $276 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $111 | N/A | $111 |
| Lab Test - Creatinine Level | $60 | N/A | $60 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $44 | N/A | $44 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $131 | N/A | $131 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $114 | N/A | $114 |
| Lab Test - Detection test for Influenza Virus | $35 | N/A | $35 |
| Mammogram (outpatient) | $1,198 | N/A | $1,198 |
| Office Visit - Basic | $92 | N/A | $92 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | N/A | $228 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $256 | N/A | $256 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $275 | N/A | $275 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $307 | N/A | $307 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | N/A | $227 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | N/A | $224 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $200 | N/A | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $239 | N/A | $239 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $240 | N/A | $240 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $263 | N/A | $263 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $195 | N/A | $195 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | N/A | $195 |
| Office Visit - Established Patient, High Complexity | $307 | N/A | $307 |
| Office Visit - Established Patient, Low Complexity | $154 | N/A | $154 |
| Office Visit - Established Patient, Moderate Complexity | $228 | N/A | $228 |
| Office Visit - New Patient, Low Complexity | $228 | N/A | $228 |
| Office Visit - New Patient, Minor | $159 | N/A | $159 |
| Office Visit - New Patient, Moderate Complexity | $349 | N/A | $349 |
| Pap Test, automated screening and manual rescreening | $254 | N/A | $254 |
| Pap Test, manual screening | $80 | N/A | $80 |
| Physical Therapy - Low Complexity Evaluation | $243 | 
Near Average
State Average: 1 | $243 |
| Physical Therapy - Manual Therapy | $97 | 
Below Average
State Average: 4 | $97 |
| Physical Therapy - Therapeutic Exercises | $138 |
Below Average
State Average: 4 | $138 |
| Psychiatric Diagnostic Evaluation | $210 |
Near Average
State Average: 1 | $210 |
| Psychotherapy - 30 Minutes | $137 |
Near Average
State Average: 1 | $137 |
| Psychotherapy - 45 Minutes | $158 |
Near Average
State Average: 4 | $158 |
| Psychotherapy - 60 Minutes | $158 |
Below Average
State Average: 5 | $158 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $93 | N/A | $93 |
| Ultrasound - Breast (outpatient) | $2,218 | N/A | $2,218 |
| Urine Capacity Measurement | $352 | N/A | $352 |
| Urine Test - Automated with Microscope Examination | $106 | N/A | $106 |
| Urine Test - Automated without Microscope | $17 | N/A | $17 |
| Urine Test - Bacterial Culture | $31 | N/A | $31 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $85 | N/A | $85 |
| Urine Test - Chlamydia | $180 | N/A | $180 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $228 | N/A | $228 |
| Urine Test - Microalbumin (Protein) Level | $77 | N/A | $77 |
| Urine Test - Pregnancy | $18 | N/A | $18 |
| Urine Test - Urinalysis, Manual Test | $5 | N/A | $5 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $39 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $373 | N/A | $373 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $112 | N/A | $112 |
| X-Ray - Foot (outpatient) | $691 | N/A | $691 |
| X-Ray - Hand | $1,014 | N/A | $1,014 |
