| Arthrocentesis (outpatient) | $393 | N/A | $393 |
| Bacterial Culture - Aerobic Isolates | $13 | N/A | $13 |
| Bacterial Culture - Swab | $17 | N/A | $17 |
| Blood Test - Basic Metabolic Panel | $16 | N/A | $16 |
| Blood Test - Blood Glucose (Sugar) Level | $7 | N/A | $7 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $19 | N/A | $19 |
| Blood Test - Blood Typing (ABO) | $5 | N/A | $5 |
| Blood Test - Blood Typing (Rh (D)) | $5 | N/A | $5 |
| Blood Test - C-reactive Protein (CRP) Level | $9 | N/A | $9 |
| Blood Test - Cholesterol Test, Lipid Panel | $26 | N/A | $26 |
| Blood Test - Clotting Time | $7 | N/A | $7 |
| Blood Test - Coagulation Assessment | $12 | N/A | $12 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $13 | N/A | $13 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $15 | N/A | $15 |
| Blood Test - Comprehensive Metabolic Panel | $20 | N/A | $20 |
| Blood Test - Creatinine Level | $9 | N/A | $9 |
| Blood Test - Electrolytes Panel | $14 | N/A | $14 |
| Blood Test - Ferritin (Blood Protein) Level | $26 | N/A | $26 |
| Blood Test - Folic Acid Level | $28 | N/A | $28 |
| Blood Test - General Health Panel | $67 | N/A | $67 |
| Blood Test - Hepatic (Liver) Function Panel | $16 | N/A | $16 |
| Blood Test - Hepatitis C Antibody Level | $25 | N/A | $25 |
| Blood Test - Iron Binding Capacity | $17 | N/A | $17 |
| Blood Test - Iron Level | $13 | N/A | $13 |
| Blood Test - Lead Level | $23 | N/A | $23 |
| Blood Test - Lipase (fat enzyme) Level | $14 | N/A | $14 |
| Blood Test - Magnesium Level | $13 | N/A | $13 |
| Blood Test - Pregnancy (Obstetric) Panel | $191 | N/A | $191 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $28 | N/A | $28 |
| Blood Test - Renal (Kidney) Function Panel | $17 | N/A | $17 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $26 | N/A | $26 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $33 | N/A | $33 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $17 | N/A | $17 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $32 | N/A | $32 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $23 | N/A | $23 |
| Blood Test - Vitamin D-3 Level | $56 | N/A | $56 |
| Bone Density Scan (outpatient) | $743 | N/A | $743 |
| CT Scan - Abdomen and Pelvis, with Contrast | $2,078 | N/A | $2,078 |
| CT Scan - Chest, with Contrast (outpatient) | $2,459 | N/A | $2,459 |
| Destruction of Lesion (outpatient) | $445 | N/A | $445 |
| Developmental Screening | $53 | N/A | $53 |
| Electrocardiogram (ECG or EKG), Tracing | $417 | N/A | $417 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $277 | N/A | $277 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $17 | N/A | $17 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $19 | N/A | $19 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $42 | N/A | $42 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $59 | N/A | $59 |
| Lab Test - Detection test for Influenza Virus | $20 | N/A | $20 |
| Lab Test - Smear for Microorganism | $8 | N/A | $8 |
| Laryngoscopy - Diagnostic | $548 | N/A | $548 |
| Mammogram (outpatient) | $819 | N/A | $819 |
| MRI - Back (outpatient) | $2,844 | N/A | $2,844 |
| MRI - Brain (outpatient) | $4,477 | N/A | $4,477 |
| MRI - Knee (outpatient) | $2,856 | N/A | $2,856 |
| MRI - Pelvis (outpatient) | $4,473 | N/A | $4,473 |
| Nasal Endoscopy - Diagnostic | $615 | N/A | $615 |
| Office Visit - Basic | $97 | N/A | $97 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $273 | N/A | $273 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $320 | N/A | $320 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $311 | N/A | $311 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $361 | N/A | $361 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $284 | N/A | $284 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $261 | N/A | $261 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $251 | N/A | $251 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $274 | N/A | $274 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $279 | N/A | $279 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $298 | N/A | $298 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $250 | N/A | $250 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $234 | N/A | $234 |
| Office Visit - Established Patient, High Complexity | $317 | N/A | $317 |
| Office Visit - Established Patient, Low Complexity | $160 | N/A | $160 |
| Office Visit - Established Patient, Moderate Complexity | $235 | N/A | $235 |
| Office Visit - New Patient, Low Complexity | $256 | N/A | $256 |
| Office Visit - New Patient, Minor | $165 | N/A | $165 |
| Office Visit - New Patient, Moderate Complexity | $390 | N/A | $390 |
| Pap Test, automated screening and manual rescreening | $40 | N/A | $40 |
| Physical Therapy - Electrical Stimulation Therapy | $32 | 
Above Average
State Average: 3 | $32 |
| Physical Therapy - Low Complexity Evaluation | $137 | 
Near Average
State Average: 1 | $137 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $37 | 
Below Average
State Average: 3 | $37 |
| Physical Therapy - Manual Therapy | $116 |
Near Average
State Average: 4 | $116 |
| Physical Therapy - Moderate Complexity Evaluation | $147 |
Near Average
State Average: 1 | $147 |
| Physical Therapy - Neuromuscular Reeducation | $53 |
Below Average
State Average: 4 | $53 |
| Physical Therapy - Re-Evaluation | $79 |
Near Average
State Average: 1 | $79 |
| Physical Therapy - Therapeutic Activities | $53 |
Below Average
State Average: 3 | $53 |
| Physical Therapy - Therapeutic Exercises | $95 |
Near Average
State Average: 4 | $95 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $12 | N/A | $12 |
| Ultrasound - Breast (outpatient) | $909 | N/A | $909 |
| Urine Capacity Measurement | $216 | N/A | $216 |
| Urine Test - Automated with Microscope Examination | $6 | N/A | $6 |
| Urine Test - Automated without Microscope | $3 | N/A | $3 |
| Urine Test - Bacterial Culture | $8 | N/A | $8 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $13 | N/A | $13 |
| Urine Test - Chlamydia | $48 | N/A | $48 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $49 | N/A | $49 |
| Urine Test - Microalbumin (Protein) Level | $11 | N/A | $11 |
| Urine Test - Pregnancy | $13 | N/A | $13 |
| Urine Test - Urinalysis, Manual Test | $16 | N/A | $16 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $39 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $397 | N/A | $397 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $64 | N/A | $64 |
| X-Ray - Ankle (outpatient) | $341 | N/A | $341 |
| X-Ray - Chest (outpatient) | $429 | N/A | $429 |
| X-Ray - Foot (outpatient) | $340 | N/A | $340 |
| X-Ray - Hip | $207 | N/A | $207 |
| X-Ray - Knee (outpatient) | $202 | N/A | $202 |
| X-Ray - Spine (outpatient) | $477 | N/A | $477 |
| X-Ray - Wrist (outpatient) | $551 | N/A | $551 |
