| Ambulance Service - Emergency Transport, Advanced Life Support | $785 | N/A | $785 |
| Ambulance Service - Mileage Rate for Ambulance Transport | $28 | N/A | $28 |
| Arthrocentesis (outpatient) | $1,708 | N/A | $1,708 |
| Bacterial Culture - Aerobic Isolates | $93 | N/A | $93 |
| Bacterial Culture - Swab | $175 | N/A | $175 |
| Biopsy - Breast | $6,033 | N/A | $6,033 |
| Biopsy - Endometrial (Uterus) | $1,161 | N/A | $1,161 |
| Biopsy - Tangential Biopsy of Skin | $746 | N/A | $746 |
| Blood Test - Basic Metabolic Panel | $139 | N/A | $139 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $93 | N/A | $93 |
| Blood Test - Blood Typing (ABO) | $97 | N/A | $97 |
| Blood Test - Blood Typing (Rh (D)) | $69 | N/A | $69 |
| Blood Test - C-reactive Protein (CRP) Level | $143 | N/A | $143 |
| Blood Test - Cholesterol Test, Lipid Panel | $164 | N/A | $164 |
| Blood Test - Clotting Time | $83 | N/A | $83 |
| Blood Test - Coagulation Assessment | $164 | N/A | $164 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $83 | N/A | $83 |
| Blood Test - Comprehensive Metabolic Panel | $164 | N/A | $164 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $63 | N/A | $63 |
| Blood Test - Creatinine Level | $75 | N/A | $75 |
| Blood Test - Electrolytes Panel | $124 | N/A | $124 |
| Blood Test - Ferritin (Blood Protein) Level | $128 | N/A | $128 |
| Blood Test - General Health Panel | $279 | N/A | $279 |
| Blood Test - Hepatic (Liver) Function Panel | $131 | N/A | $131 |
| Blood Test - Hepatitis B Surface Antibody Level | $69 | N/A | $69 |
| Blood Test - Hepatitis C Antibody Level | $173 | N/A | $173 |
| Blood Test - Iron Binding Capacity | $104 | N/A | $104 |
| Blood Test - Iron Level | $104 | N/A | $104 |
| Blood Test - Lead Level | $101 | N/A | $101 |
| Blood Test - Lipase (fat enzyme) Level | $69 | N/A | $69 |
| Blood Test - Magnesium Level | $80 | N/A | $80 |
| Blood Test - Pregnancy (Obstetric) Panel | $250 | N/A | $250 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $110 | N/A | $110 |
| Blood Test - Renal (Kidney) Function Panel | $135 | N/A | $135 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $135 | N/A | $135 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $182 | N/A | $182 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $211 | N/A | $211 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $242 | N/A | $242 |
| Blood Test - Vitamin D-3 Level | $86 | N/A | $86 |
| Bone Density Scan (outpatient) | $646 | N/A | $646 |
| CT Scan - Abdomen and Pelvis, with Contrast | $5,025 | N/A | $5,025 |
| CT Scan - Chest, with Contrast (outpatient) | $2,531 | N/A | $2,531 |
| CT Scan - Head/Brain, without Contrast | $1,887 | N/A | $1,887 |
| Developmental Screening | $53 | N/A | $53 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $451 | N/A | $451 |
| Emergency Department Visit - Low Complexity (outpatient) | $439 | N/A | $439 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $629 | N/A | $629 |
| Fetal Non-Stress Test | $1,373 | N/A | $1,373 |
| Hydration Infusion | $125 | N/A | $125 |
| Lab Test - Creatinine Level | $53 | N/A | $53 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $53 | N/A | $53 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $131 | N/A | $131 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $173 | N/A | $173 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $104 | N/A | $104 |
| Lab Test - Detection test for Influenza Virus | $53 | N/A | $53 |
| Lab Test - Smear for Microorganism | $67 | N/A | $67 |
| Mammogram (outpatient) | $1,070 | N/A | $1,070 |
| MRI - Brain (outpatient) | $2,934 | N/A | $2,934 |
| MRI - Knee (outpatient) | $2,053 | N/A | $2,053 |
| Myocardial Imaging (outpatient) | $4,509 | N/A | $4,509 |
| Office Visit - Basic | $169 | N/A | $169 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $401 | N/A | $401 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $453 | N/A | $453 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $321 | N/A | $321 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $341 | N/A | $341 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $360 | N/A | $360 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $373 | N/A | $373 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $394 | N/A | $394 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $341 | N/A | $341 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $302 | N/A | $302 |
| Office Visit - Established Patient, Low Complexity | $201 | N/A | $201 |
| Office Visit - Established Patient, Moderate Complexity | $346 | N/A | $346 |
| Office Visit - New Patient, Low Complexity | $340 | N/A | $340 |
| Pap Test, automated screening and manual rescreening | $75 | N/A | $75 |
| Pap Test, manual screening | $171 | N/A | $171 |
| Physical Therapy - Manual Therapy | $147 | 
Above Average
State Average: 4 | $147 |
| Physical Therapy - Therapeutic Exercises | $147 | 
Below Average
State Average: 4 | $147 |
| Physical Therapy - Walking Training, 15 minutes | $137 | 
Near Average
State Average: 1 | $137 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $143 | N/A | $143 |
| Ultrasound - Abdominal, Complete | $1,408 | N/A | $1,408 |
| Ultrasound - Abdominal, Limited | $1,007 | N/A | $1,007 |
| Ultrasound - Breast (outpatient) | $2,247 | N/A | $2,247 |
| Ultrasound - Head and Neck | $833 | N/A | $833 |
| Ultrasound - Pregnancy (outpatient) | $1,010 | N/A | $1,010 |
| Ultrasound - Pregnancy Follow-Up | $767 | N/A | $767 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $4,184 | N/A | $4,184 |
| Urine Test - Automated with Microscope Examination | $83 | N/A | $83 |
| Urine Test - Automated without Microscope | $83 | N/A | $83 |
| Urine Test - Chlamydia | $185 | N/A | $185 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $185 | N/A | $185 |
| Urine Test - Microalbumin (Protein) Level | $48 | N/A | $48 |
| Urine Test - Pregnancy | $104 | N/A | $104 |
| Urine Test - Urinalysis, Manual Test | $53 | N/A | $53 |
| Vaccine - Influenza for Injection into Muscle | $46 | N/A | $46 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $322 | N/A | $322 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $123 | N/A | $123 |
| X-Ray - Abdomen | $1,285 | N/A | $1,285 |
| X-Ray - Ankle (outpatient) | $611 | N/A | $611 |
| X-Ray - Chest (outpatient) | $716 | N/A | $716 |
| X-Ray - Foot (outpatient) | $678 | N/A | $678 |
| X-Ray - Hand | $852 | N/A | $852 |
| X-Ray - Hip | $845 | N/A | $845 |
| X-Ray - Knee (outpatient) | $681 | N/A | $681 |
| X-Ray - Shoulder (outpatient) | $664 | N/A | $664 |
| X-Ray - Spine (outpatient) | $994 | N/A | $994 |
| X-Ray - Wrist (outpatient) | $686 | N/A | $686 |
