| Bacterial Culture - Aerobic Isolates | $34 | N/A | $34 |
| Bacterial Culture - Swab | $53 | N/A | $53 |
| Blood Test - Basic Metabolic Panel | $64 | N/A | $64 |
| Blood Test - Blood Glucose (Sugar) Level | $30 | N/A | $30 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $61 | N/A | $61 |
| Blood Test - Blood Typing (ABO) | $81 | N/A | $81 |
| Blood Test - Blood Typing (Rh (D)) | $75 | N/A | $75 |
| Blood Test - C-reactive Protein (CRP) Level | $30 | N/A | $30 |
| Blood Test - Cholesterol Test, Lipid Panel | $76 | N/A | $76 |
| Blood Test - Clotting Time | $67 | N/A | $67 |
| Blood Test - Coagulation Assessment | $106 | N/A | $106 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $39 | N/A | $39 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $36 | N/A | $36 |
| Blood Test - Comprehensive Metabolic Panel | $81 | N/A | $81 |
| Blood Test - Creatinine Level | $36 | N/A | $36 |
| Blood Test - Electrolytes Panel | $35 | N/A | $35 |
| Blood Test - Ferritin (Blood Protein) Level | $82 | N/A | $82 |
| Blood Test - Folic Acid Level | $83 | N/A | $83 |
| Blood Test - General Health Panel | $229 | N/A | $229 |
| Blood Test - Hepatic (Liver) Function Panel | $66 | N/A | $66 |
| Blood Test - Hepatitis B Surface Antibody Level | $81 | N/A | $81 |
| Blood Test - Hepatitis C Antibody Level | $107 | N/A | $107 |
| Blood Test - LDL Cholesterol Level | $55 | N/A | $55 |
| Blood Test - Lead Level | $81 | N/A | $81 |
| Blood Test - Lipase (fat enzyme) Level | $55 | N/A | $55 |
| Blood Test - Magnesium Level | $46 | N/A | $46 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $109 | N/A | $109 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $86 | N/A | $86 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $116 | N/A | $116 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $46 | N/A | $46 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $65 | N/A | $65 |
| Blood Test - Vitamin D-3 Level | $203 | N/A | $203 |
| Colonoscopy - Diagnostic (outpatient) | $4,760 | N/A | $4,760 |
| Colonoscopy - With Biopsy (outpatient) | $6,189 | N/A | $6,189 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,896 | N/A | $6,896 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,526 | N/A | $2,526 |
| Developmental Screening | $26 | N/A | $26 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $523 | N/A | $523 |
| Emergency Department Visit - Low Complexity (outpatient) | $660 | N/A | $660 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $660 | N/A | $660 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $47 | N/A | $47 |
| Fetal Non-Stress Test | $1,786 | N/A | $1,786 |
| Hydration Infusion | $93 | N/A | $93 |
| Lab Test - Creatinine Level | $33 | N/A | $33 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $43 | N/A | $43 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $79 | N/A | $79 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $175 | N/A | $175 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $207 | N/A | $207 |
| Lab Test - Detection test for Influenza Virus | $36 | N/A | $36 |
| Lab Test - Smear for Microorganism | $17 | N/A | $17 |
| Mammogram (outpatient) | $800 | N/A | $800 |
| MRI - Back (outpatient) | $2,907 | N/A | $2,907 |
| Office Visit - Basic | $141 | N/A | $141 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $312 | N/A | $312 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $411 | N/A | $411 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $439 | N/A | $439 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $265 | N/A | $265 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $244 | N/A | $244 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $234 | N/A | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $257 | N/A | $257 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $305 | N/A | $305 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $319 | N/A | $319 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $236 | N/A | $236 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $218 | N/A | $218 |
| Office Visit - Established Patient, High Complexity | $394 | N/A | $394 |
| Office Visit - Established Patient, Low Complexity | $216 | N/A | $216 |
| Office Visit - Established Patient, Moderate Complexity | $311 | N/A | $311 |
| Office Visit - New Patient, Low Complexity | $305 | N/A | $305 |
| Office Visit - New Patient, Minor | $218 | N/A | $218 |
| Office Visit - New Patient, Moderate Complexity | $473 | N/A | $473 |
| Pap Test, automated screening and manual rescreening | $155 | N/A | $155 |
| Pap Test, manual screening | $169 | N/A | $169 |
| Physical Therapy - Low Complexity Evaluation | $292 | 
Near Average
State Average: 1 | $292 |
| Physical Therapy - Manual Therapy | $116 | 
Below Average
State Average: 4 | $116 |
| Physical Therapy - Moderate Complexity Evaluation | $296 |
Near Average
State Average: 1 | $296 |
| Physical Therapy - Self-care or Home Management Training | $137 |
Near Average
State Average: 1 | $137 |
| Physical Therapy - Therapeutic Exercises | $126 | 
Above Average
State Average: 4 | $126 |
| Physical Therapy - Walking Training, 15 minutes | $113 |
Near Average
State Average: 1 | $113 |
| Psychotherapy - 30 Minutes | $80 |
Above Average
State Average: 1 | $80 |
| Psychotherapy - 45 Minutes | $112 |
Above Average
State Average: 4 | $112 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $41 | N/A | $41 |
| Ultrasound - Abdominal, Complete | $783 | N/A | $783 |
| Ultrasound - Breast (outpatient) | $1,298 | N/A | $1,298 |
| Ultrasound - Head and Neck | $525 | N/A | $525 |
| Ultrasound - Pregnancy Follow-Up | $653 | N/A | $653 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $5,403 | N/A | $5,403 |
| Urine Capacity Measurement | $453 | N/A | $453 |
| Urine Test - Automated without Microscope | $14 | N/A | $14 |
| Urine Test - Bacterial Culture | $48 | N/A | $48 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $51 | N/A | $51 |
| Urine Test - Chlamydia | $139 | N/A | $139 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $139 | N/A | $139 |
| Urine Test - Microalbumin (Protein) Level | $30 | N/A | $30 |
| Urine Test - Pregnancy | $43 | N/A | $43 |
| Urine Test - Urinalysis, Manual Test | $19 | N/A | $19 |
| Vaccine - Influenza for Injection into Muscle | $35 | N/A | $35 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $74 | N/A | $74 |
| X-Ray - Abdomen | $582 | N/A | $582 |
| X-Ray - Chest (outpatient) | $443 | N/A | $443 |
| X-Ray - Foot (outpatient) | $389 | N/A | $389 |
