| Arthrocentesis (outpatient) | $465 | N/A | $200 |
| Arthroscopic Knee Surgery (outpatient) | $15,658 | N/A | $6,733 |
| Arthroscopic Shoulder Surgery | $40,207 | N/A | $17,289 |
| Bacterial Culture - Aerobic Isolates | $88 | N/A | $38 |
| Bacterial Culture - Swab | $100 | N/A | $43 |
| Biopsy - Breast | $8,110 | N/A | $3,487 |
| Biopsy - Endometrial (Uterus) | $1,421 | N/A | $611 |
| Biopsy - Punch Biopsy of Skin | $1,052 | N/A | $452 |
| Biopsy - Tangential Biopsy of Skin | $901 | N/A | $387 |
| Blood Test - Basic Metabolic Panel | $75 | N/A | $32 |
| Blood Test - Blood Glucose (Sugar) Level | $43 | N/A | $19 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $122 | N/A | $52 |
| Blood Test - Blood Typing (ABO) | $78 | N/A | $34 |
| Blood Test - Blood Typing (Rh (D)) | $78 | N/A | $34 |
| Blood Test - C-reactive Protein (CRP) Level | $93 | N/A | $40 |
| Blood Test - Cholesterol Test, Lipid Panel | $146 | N/A | $63 |
| Blood Test - Clotting Time | $69 | N/A | $29 |
| Blood Test - Coagulation Assessment | $116 | N/A | $50 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $63 | N/A | $27 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $104 | N/A | $45 |
| Blood Test - Comprehensive Metabolic Panel | $93 | N/A | $40 |
| Blood Test - Coronavirus (COVID-19) Antibody Level | $63 | N/A | $27 |
| Blood Test - Creatinine Level | $39 | N/A | $17 |
| Blood Test - Electrolytes Panel | $83 | N/A | $36 |
| Blood Test - Ferritin (Blood Protein) Level | $138 | N/A | $59 |
| Blood Test - Folic Acid Level | $134 | N/A | $58 |
| Blood Test - General Health Panel | $386 | N/A | $166 |
| Blood Test - Hepatic (Liver) Function Panel | $107 | N/A | $46 |
| Blood Test - Hepatitis B Surface Antibody Level | $117 | N/A | $50 |
| Blood Test - Hepatitis C Antibody Level | $145 | N/A | $62 |
| Blood Test - Iron Binding Capacity | $86 | N/A | $37 |
| Blood Test - Iron Level | $89 | N/A | $38 |
| Blood Test - LDL Cholesterol Level | $80 | N/A | $34 |
| Blood Test - Lead Level | $25 | N/A | $11 |
| Blood Test - Lipase (fat enzyme) Level | $156 | N/A | $67 |
| Blood Test - Magnesium Level | $110 | N/A | $47 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $155 | N/A | $66 |
| Blood Test - Renal (Kidney) Function Panel | $73 | N/A | $31 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $185 | N/A | $79 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $189 | N/A | $81 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $129 | N/A | $55 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $188 | N/A | $81 |
| Blood Test - Vitamin D-3 Level | $252 | N/A | $108 |
| Bone Density Scan (outpatient) | $582 | N/A | $250 |
| Colonoscopy - Diagnostic (outpatient) | $6,397 | N/A | $2,751 |
| Colonoscopy - With Biopsy (outpatient) | $6,913 | N/A | $2,973 |
| Colonoscopy - With Polyp Removal (outpatient) | $7,368 | N/A | $3,168 |
| CT Scan - Abdomen and Pelvis, with Contrast | $4,405 | N/A | $1,894 |
| CT Scan - Chest, with Contrast (outpatient) | $2,566 | N/A | $1,103 |
| CT Scan - Head/Brain, without Contrast | $2,288 | N/A | $984 |
| Cystoscopy | $1,243 | N/A | $535 |
| Destruction of Lesion (outpatient) | $446 | N/A | $192 |
| Destruction of Lesions, up to 14 | $523 | N/A | $225 |
| Developmental Screening | $28 | N/A | $12 |
| Electrocardiogram (ECG or EKG), Tracing | $775 | N/A | $333 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $330 | N/A | $142 |
| Emergency Department Visit - Low Complexity (outpatient) | $489 | N/A | $210 |
| Emergency Department Visit - Minor (outpatient) | $411 | N/A | $177 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $725 | N/A | $312 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $106 | N/A | $46 |
| Fetal Non-Stress Test | $1,040 | N/A | $447 |
| Gall Bladder Surgery (outpatient) | $21,119 | N/A | $9,081 |
| Hernia Repair - Laparoscopic (outpatient) | $25,762 | N/A | $11,078 |
| Hydration Infusion | $132 | N/A | $57 |
| Lab Test - Creatinine Level | $74 | N/A | $32 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $30 | N/A | $13 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $205 | N/A | $88 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $113 | N/A | $48 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $187 | N/A | $81 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $392 | N/A | $168 |
| Lab Test - Detection test for Influenza Virus | $37 | N/A | $16 |
| Lab Test - Smear for Microorganism | $65 | N/A | $28 |
| Mammogram (outpatient) | $798 | N/A | $343 |
| MRI - Back (outpatient) | $2,800 | N/A | $1,204 |
| MRI - Brain (outpatient) | $4,975 | N/A | $2,139 |
| MRI - Knee (outpatient) | $3,129 | N/A | $1,346 |
| MRI - Pelvis (outpatient) | $5,690 | N/A | $2,447 |
| MRI - Shoulder, Elbow, or Wrist | $3,072 | N/A | $1,321 |
| Myocardial Imaging (outpatient) | $10,277 | N/A | $4,419 |
| Office Visit - Basic | $109 | N/A | $47 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $280 | N/A | $121 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $337 | N/A | $145 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $326 | N/A | $140 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $378 | N/A | $163 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $298 | N/A | $128 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $274 | N/A | $118 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $264 | N/A | $113 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $288 | N/A | $124 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $294 | N/A | $126 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $313 | N/A | $135 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $263 | N/A | $113 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $247 | N/A | $106 |
| Office Visit - Established Patient, High Complexity | $359 | N/A | $154 |
| Office Visit - Established Patient, Low Complexity | $183 | N/A | $79 |
| Office Visit - Established Patient, Moderate Complexity | $268 | N/A | $115 |
| Office Visit - New Patient, Low Complexity | $267 | N/A | $115 |
| Office Visit - New Patient, Minor | $186 | N/A | $80 |
| Office Visit - New Patient, Moderate Complexity | $405 | N/A | $174 |
| Pap Test, automated screening and manual rescreening | $166 | N/A | $71 |
| Pap Test, manual screening | $166 | N/A | $72 |
| Physical Therapy - Application of Hot or Cold Pack | $33 | 
Below Average
State Average: 3 | $14 |
| Physical Therapy - High Complexity Evaluation | $488 | 
Near Average
State Average: 1 | $210 |
| Physical Therapy - Low Complexity Evaluation | $488 |
Near Average
State Average: 1 | $210 |
| Physical Therapy - Manual Therapy | $154 |
Near Average
State Average: 4 | $66 |
| Physical Therapy - Moderate Complexity Evaluation | $474 |
Near Average
State Average: 1 | $204 |
| Physical Therapy - Self-care or Home Management Training | $138 |
Near Average
State Average: 1 | $59 |
| Physical Therapy - Therapeutic Activities | $137 |
Below Average
State Average: 3 | $59 |
| Physical Therapy - Therapeutic Exercises | $144 |
Near Average
State Average: 4 | $62 |
| Physical Therapy - Ultrasound Therapy | $125 |
Near Average
State Average: 3 | $54 |
| Physical Therapy - Walking Training, 15 minutes | $129 | 
Above Average
State Average: 1 | $55 |
| Psychiatric Diagnostic Evaluation | $277 |
Near Average
State Average: 1 | $119 |
| Psychotherapy - 30 Minutes | $167 |
Near Average
State Average: 1 | $72 |
| Psychotherapy - 45 Minutes | $148 |
Near Average
State Average: 4 | $64 |
| Psychotherapy - 60 Minutes | $158 |
Below Average
State Average: 5 | $68 |
| Psychotherapy - Family Session | $131 |
Below Average
State Average: 3 | $56 |
| Psychotherapy - Group Session | $517 |
Above Average
State Average: 5 | $222 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $76 | N/A | $33 |
| Ultrasound - Abdominal, Complete | $1,230 | N/A | $529 |
| Ultrasound - Abdominal, Limited | $901 | N/A | $387 |
| Ultrasound - Breast (outpatient) | $966 | N/A | $415 |
| Ultrasound - Head and Neck | $712 | N/A | $306 |
| Ultrasound - Pelvic (outpatient) | $613 | N/A | $264 |
| Ultrasound - Pregnancy (outpatient) | $405 | N/A | $174 |
| Ultrasound - Pregnancy Follow-Up | $445 | N/A | $191 |
| Ultrasound - Transvaginal (non-maternity) | $604 | N/A | $260 |
| Upper Gastrointestinal Endoscopy - Diagnostic | $4,395 | N/A | $1,890 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $6,397 | N/A | $2,751 |
| Urine Capacity Measurement | $323 | N/A | $139 |
| Urine Test - Automated with Microscope Examination | $64 | N/A | $28 |
| Urine Test - Automated without Microscope | $32 | N/A | $14 |
| Urine Test - Bacterial Culture | $32 | N/A | $14 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $63 | N/A | $27 |
| Urine Test - Chlamydia | $196 | N/A | $84 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $196 | N/A | $84 |
| Urine Test - Microalbumin (Protein) Level | $98 | N/A | $42 |
| Urine Test - Pregnancy | $16 | N/A | $7 |
| Urine Test - Urinalysis, Manual Test | $7 | N/A | $3 |
| Vaccine - Influenza for Injection into Muscle | $41 | N/A | $18 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $296 | N/A | $127 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $70 | N/A | $30 |
| X-Ray - Abdomen | $663 | N/A | $285 |
| X-Ray - Ankle (outpatient) | $577 | N/A | $248 |
| X-Ray - Chest (outpatient) | $615 | N/A | $264 |
| X-Ray - Foot (outpatient) | $551 | N/A | $237 |
| X-Ray - Hand | $578 | N/A | $249 |
| X-Ray - Hip | $644 | N/A | $277 |
| X-Ray - Knee (outpatient) | $589 | N/A | $253 |
| X-Ray - Middle Back, Thoracic Spine | $1,009 | N/A | $434 |
| X-Ray - Neck, Cervical Spine | $605 | N/A | $260 |
| X-Ray - Pelvis | $506 | N/A | $217 |
| X-Ray - Shoulder (outpatient) | $579 | N/A | $249 |
| X-Ray - Spine (outpatient) | $710 | N/A | $305 |
| X-Ray - Wrist (outpatient) | $546 | N/A | $235 |
