| Arthrocentesis (outpatient) | $463 | N/A | $282 |
| Bacterial Culture - Aerobic Isolates | $88 | N/A | $54 |
| Bacterial Culture - Swab | $102 | N/A | $62 |
| Blood Test - Basic Metabolic Panel | $106 | N/A | $65 |
| Blood Test - Blood Glucose (Sugar) Level | $51 | N/A | $31 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $95 | N/A | $58 |
| Blood Test - Blood Typing (ABO) | $130 | N/A | $79 |
| Blood Test - Blood Typing (Rh (D)) | $112 | N/A | $69 |
| Blood Test - C-reactive Protein (CRP) Level | $153 | N/A | $94 |
| Blood Test - Cholesterol Test, Lipid Panel | $167 | N/A | $102 |
| Blood Test - Clotting Time | $61 | N/A | $37 |
| Blood Test - Coagulation Assessment | $96 | N/A | $58 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $98 | N/A | $60 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $110 | N/A | $67 |
| Blood Test - Comprehensive Metabolic Panel | $165 | N/A | $101 |
| Blood Test - Creatinine Level | $82 | N/A | $50 |
| Blood Test - Electrolytes Panel | $85 | N/A | $52 |
| Blood Test - Ferritin (Blood Protein) Level | $160 | N/A | $97 |
| Blood Test - Folic Acid Level | $184 | N/A | $112 |
| Blood Test - General Health Panel | $155 | N/A | $95 |
| Blood Test - Hepatic (Liver) Function Panel | $128 | N/A | $78 |
| Blood Test - Hepatitis B Surface Antibody Level | $126 | N/A | $77 |
| Blood Test - Hepatitis C Antibody Level | $137 | N/A | $83 |
| Blood Test - Iron Binding Capacity | $70 | N/A | $43 |
| Blood Test - Iron Level | $69 | N/A | $42 |
| Blood Test - Lead Level | $66 | N/A | $40 |
| Blood Test - Lipase (fat enzyme) Level | $123 | N/A | $75 |
| Blood Test - Magnesium Level | $110 | N/A | $67 |
| Blood Test - Pregnancy (Obstetric) Panel | $442 | N/A | $270 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $181 | N/A | $110 |
| Blood Test - Renal (Kidney) Function Panel | $102 | N/A | $62 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $156 | N/A | $95 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $155 | N/A | $95 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $123 | N/A | $75 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $159 | N/A | $97 |
| Blood Test - Vitamin D-3 Level | $224 | N/A | $136 |
| Bone Density Scan (outpatient) | $522 | N/A | $318 |
| Colonoscopy - Diagnostic (outpatient) | $5,691 | N/A | $3,471 |
| Colonoscopy - With Biopsy (outpatient) | $6,656 | N/A | $4,060 |
| Colonoscopy - With Polyp Removal (outpatient) | $6,481 | N/A | $3,954 |
| CT Scan - Abdomen and Pelvis, with Contrast | $3,881 | N/A | $2,367 |
| CT Scan - Chest, with Contrast (outpatient) | $2,637 | N/A | $1,608 |
| Electrocardiogram (ECG or EKG), Tracing | $597 | N/A | $364 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $349 | N/A | $213 |
| Emergency Department Visit - Low Complexity (outpatient) | $471 | N/A | $288 |
| Emergency Department Visit - Minor (outpatient) | $275 | N/A | $168 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $736 | N/A | $449 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $103 | N/A | $63 |
| Fetal Non-Stress Test | $699 | N/A | $427 |
| Gall Bladder Surgery (outpatient) | $17,324 | N/A | $10,567 |
| Hydration Infusion | $232 | N/A | $142 |
| Lab Test - Creatinine Level | $85 | N/A | $52 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $79 | N/A | $48 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $135 | N/A | $83 |
| Lab Test - Detection test for HIV-1 and HIV-2 | $135 | N/A | $83 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $252 | N/A | $154 |
| Lab Test - Detection test for Influenza Virus | $77 | N/A | $47 |
| Lab Test - Smear for Microorganism | $21 | N/A | $13 |
| Mammogram (outpatient) | $1,022 | N/A | $623 |
| MRI - Back (outpatient) | $3,120 | N/A | $1,903 |
| MRI - Brain (outpatient) | $3,716 | N/A | $2,267 |
| MRI - Knee (outpatient) | $2,901 | N/A | $1,770 |
| MRI - Pelvis (outpatient) | $4,137 | N/A | $2,524 |
| MRI - Shoulder, Elbow, or Wrist | $2,872 | N/A | $1,752 |
| Myocardial Imaging (outpatient) | $7,089 | N/A | $4,324 |
| Office Visit - Basic | $89 | N/A | $54 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $263 | N/A | $160 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $272 | N/A | $166 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $298 | N/A | $182 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $359 | N/A | $219 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $237 | N/A | $145 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $265 | N/A | $161 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $256 | N/A | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $247 | N/A | $151 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $263 | N/A | $160 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $328 | N/A | $200 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $256 | N/A | $156 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $196 | N/A | $120 |
| Office Visit - Established Patient, High Complexity | $377 | N/A | $230 |
| Office Visit - Established Patient, Low Complexity | $180 | N/A | $110 |
| Office Visit - Established Patient, Moderate Complexity | $275 | N/A | $168 |
| Office Visit - New Patient, Low Complexity | $269 | N/A | $164 |
| Office Visit - New Patient, Minor | $176 | N/A | $108 |
| Office Visit - New Patient, Moderate Complexity | $455 | N/A | $277 |
| Pap Test, automated screening and manual rescreening | $204 | N/A | $124 |
| Pap Test, manual screening | $137 | N/A | $83 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $79 | 
Below Average
State Average: 3 | $48 |
| Physical Therapy - Application of Hot or Cold Pack | $49 |
Below Average
State Average: 3 | $30 |
| Physical Therapy - Low Complexity Evaluation | $292 | 
Near Average
State Average: 1 | $178 |
| Physical Therapy - Manual Electrical Stimulation Therapy, 15 minutes | $65 |
Below Average
State Average: 3 | $40 |
| Physical Therapy - Manual Therapy | $65 | 
Above Average
State Average: 4 | $40 |
| Physical Therapy - Moderate Complexity Evaluation | $210 |
Near Average
State Average: 1 | $128 |
| Physical Therapy - Neuromuscular Reeducation | $65 |
Near Average
State Average: 4 | $40 |
| Physical Therapy - Therapeutic Exercises | $154 |
Above Average
State Average: 4 | $94 |
| Physical Therapy - Ultrasound Therapy | $72 |
Near Average
State Average: 3 | $44 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $68 | N/A | $42 |
| Ultrasound - Abdominal, Complete | $813 | N/A | $496 |
| Ultrasound - Abdominal, Limited | $755 | N/A | $461 |
| Ultrasound - Breast (outpatient) | $1,552 | N/A | $947 |
| Ultrasound - Head and Neck | $759 | N/A | $463 |
| Ultrasound - Pregnancy (outpatient) | $789 | N/A | $481 |
| Ultrasound - Pregnancy Follow-Up | $561 | N/A | $342 |
| Ultrasound - Transvaginal (non-maternity) | $1,052 | N/A | $642 |
| Urine Test - Automated with Microscope Examination | $68 | N/A | $42 |
| Urine Test - Automated without Microscope | $66 | N/A | $40 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $67 | N/A | $41 |
| Urine Test - Chlamydia | $148 | N/A | $90 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $148 | N/A | $90 |
| Urine Test - Pregnancy | $48 | N/A | $29 |
| Urine Test - Urinalysis, Manual Test | $15 | N/A | $9 |
| Vaccine - Influenza for Injection into Muscle | $39 | N/A | $24 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $340 | N/A | $208 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $88 | N/A | $54 |
| X-Ray - Abdomen | $336 | N/A | $205 |
| X-Ray - Ankle (outpatient) | $331 | N/A | $202 |
| X-Ray - Chest (outpatient) | $538 | N/A | $328 |
| X-Ray - Foot (outpatient) | $685 | N/A | $418 |
| X-Ray - Hand | $650 | N/A | $396 |
| X-Ray - Hip | $476 | N/A | $290 |
| X-Ray - Knee (outpatient) | $568 | N/A | $347 |
| X-Ray - Middle Back, Thoracic Spine | $564 | N/A | $344 |
| X-Ray - Neck, Cervical Spine | $499 | N/A | $304 |
| X-Ray - Shoulder (outpatient) | $446 | N/A | $272 |
| X-Ray - Spine (outpatient) | $517 | N/A | $315 |
| X-Ray - Wrist (outpatient) | $532 | N/A | $325 |
