| Arthrocentesis (outpatient) | $518 | N/A | $259 |
| Bacterial Culture - Aerobic Isolates | $71 | N/A | $36 |
| Bacterial Culture - Swab | $80 | N/A | $40 |
| Blood Test - Basic Metabolic Panel | $71 | N/A | $36 |
| Blood Test - Blood Glucose (Sugar) Level | $35 | N/A | $17 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $85 | N/A | $43 |
| Blood Test - Blood Typing (ABO) | $74 | N/A | $37 |
| Blood Test - Blood Typing (Rh (D)) | $32 | N/A | $16 |
| Blood Test - C-reactive Protein (CRP) Level | $43 | N/A | $22 |
| Blood Test - Cholesterol Test, Lipid Panel | $111 | N/A | $56 |
| Blood Test - Clotting Time | $41 | N/A | $20 |
| Blood Test - Coagulation Assessment | $50 | N/A | $25 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $58 | N/A | $29 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $87 | N/A | $44 |
| Blood Test - Comprehensive Metabolic Panel | $88 | N/A | $44 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $57 | N/A | $28 |
| Blood Test - Creatinine Level | $43 | N/A | $22 |
| Blood Test - Electrolytes Panel | $59 | N/A | $29 |
| Blood Test - Ferritin (Blood Protein) Level | $110 | N/A | $55 |
| Blood Test - Folic Acid Level | $123 | N/A | $61 |
| Blood Test - General Health Panel | $316 | N/A | $158 |
| Blood Test - Hepatic (Liver) Function Panel | $68 | N/A | $34 |
| Blood Test - Hepatitis B Surface Antibody Level | $89 | N/A | $45 |
| Blood Test - Hepatitis C Antibody Level | $123 | N/A | $61 |
| Blood Test - Iron Binding Capacity | $70 | N/A | $35 |
| Blood Test - Iron Level | $53 | N/A | $26 |
| Blood Test - LDL Cholesterol Level | $86 | N/A | $43 |
| Blood Test - Lead Level | $100 | N/A | $50 |
| Blood Test - Lipase (fat enzyme) Level | $70 | N/A | $35 |
| Blood Test - Magnesium Level | $82 | N/A | $41 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $119 | N/A | $59 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $134 | N/A | $67 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $141 | N/A | $70 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $129 | N/A | $65 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $141 | N/A | $70 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $154 | N/A | $77 |
| Blood Test - Vitamin D-3 Level | $247 | N/A | $123 |
| Bone Density Scan (outpatient) | $518 | N/A | $259 |
| Colonoscopy - Diagnostic (outpatient) | $7,640 | N/A | $3,820 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,448 | N/A | $1,724 |
| Developmental Screening | $50 | N/A | $25 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $381 | N/A | $191 |
| Emergency Department Visit - Low Complexity (outpatient) | $345 | N/A | $173 |
| Emergency Department Visit - Minor (outpatient) | $231 | N/A | $116 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $583 | N/A | $291 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $78 | N/A | $39 |
| Hydration Infusion | $155 | N/A | $78 |
| Lab Test - Creatinine Level | $43 | N/A | $22 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $100 | N/A | $50 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $76 | N/A | $38 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $95 | N/A | $47 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $360 | N/A | $180 |
| Lab Test - Detection test for Influenza Virus | $32 | N/A | $16 |
| Lab Test - Smear for Microorganism | $42 | N/A | $21 |
| Mammogram (outpatient) | $1,182 | N/A | $591 |
| MRI - Back (outpatient) | $3,835 | N/A | $1,917 |
| MRI - Brain (outpatient) | $6,077 | N/A | $3,039 |
| MRI - Knee (outpatient) | $3,581 | N/A | $1,790 |
| Office Visit - Basic | $104 | N/A | $52 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $328 | N/A | $164 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $348 | N/A | $174 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $413 | N/A | $206 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $328 | N/A | $164 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $305 | N/A | $152 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $254 | N/A | $127 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $323 | N/A | $162 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $328 | N/A | $164 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $389 | N/A | $194 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $254 | N/A | $127 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $229 | N/A | $114 |
| Office Visit - Established Patient, High Complexity | $306 | N/A | $153 |
| Office Visit - Established Patient, Low Complexity | $148 | N/A | $74 |
| Office Visit - Established Patient, Moderate Complexity | $233 | N/A | $117 |
| Office Visit - New Patient, Low Complexity | $268 | N/A | $134 |
| Office Visit - New Patient, Minor | $177 | N/A | $89 |
| Office Visit - New Patient, Moderate Complexity | $347 | N/A | $173 |
| Pap Test, automated screening and manual rescreening | $272 | N/A | $136 |
| Physical Therapy - High Complexity Evaluation | $368 | 
Above Average
State Average: 1 | $184 |
| Physical Therapy - Low Complexity Evaluation | $289 | 
Near Average
State Average: 1 | $144 |
| Physical Therapy - Manual Therapy | $153 | 
Below Average
State Average: 4 | $77 |
| Physical Therapy - Moderate Complexity Evaluation | $341 |
Near Average
State Average: 1 | $171 |
| Physical Therapy - Self-care or Home Management Training | $124 |
Near Average
State Average: 1 | $62 |
| Physical Therapy - Therapeutic Activities | $130 |
Below Average
State Average: 3 | $65 |
| Physical Therapy - Therapeutic Exercises | $138 |
Below Average
State Average: 4 | $69 |
| Physical Therapy - Ultrasound Therapy | $84 |
Below Average
State Average: 3 | $42 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $55 | N/A | $27 |
| Ultrasound - Abdominal, Complete | $869 | N/A | $435 |
| Ultrasound - Abdominal, Limited | $673 | N/A | $337 |
| Ultrasound - Breast (outpatient) | $1,634 | N/A | $817 |
| Ultrasound - Head and Neck | $853 | N/A | $426 |
| Ultrasound - Transvaginal (non-maternity) | $1,758 | N/A | $879 |
| Urine Test - Automated with Microscope Examination | $45 | N/A | $23 |
| Urine Test - Automated without Microscope | $35 | N/A | $17 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $65 | N/A | $33 |
| Urine Test - Chlamydia | $216 | N/A | $108 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $216 | N/A | $108 |
| Urine Test - Microalbumin (Protein) Level | $48 | N/A | $24 |
| Urine Test - Pregnancy | $62 | N/A | $31 |
| Urine Test - Urinalysis, Manual Test | $24 | N/A | $12 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $19 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $219 | N/A | $110 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $98 | N/A | $49 |
| X-Ray - Abdomen | $639 | N/A | $320 |
| X-Ray - Ankle (outpatient) | $331 | N/A | $165 |
| X-Ray - Chest (outpatient) | $433 | N/A | $216 |
| X-Ray - Foot (outpatient) | $565 | N/A | $282 |
| X-Ray - Hand | $790 | N/A | $395 |
| X-Ray - Hip | $574 | N/A | $287 |
| X-Ray - Knee (outpatient) | $600 | N/A | $300 |
| X-Ray - Shoulder (outpatient) | $625 | N/A | $312 |
| X-Ray - Spine (outpatient) | $475 | N/A | $237 |
| X-Ray - Wrist (outpatient) | $563 | N/A | $281 |
