| Arthrocentesis (outpatient) | $845 | N/A | $845 |
| Bacterial Culture - Aerobic Isolates | $47 | N/A | $47 |
| Bacterial Culture - Swab | $105 | N/A | $105 |
| Blood Test - Basic Metabolic Panel | $103 | N/A | $103 |
| Blood Test - Blood Glucose (Sugar) Level | $53 | N/A | $53 |
| Blood Test - Blood Glucose Control (Hemoglobin A1C) | $108 | N/A | $108 |
| Blood Test - Blood Typing (ABO) | $41 | N/A | $41 |
| Blood Test - Blood Typing (Rh (D)) | $74 | N/A | $74 |
| Blood Test - C-reactive Protein (CRP) Level | $47 | N/A | $47 |
| Blood Test - Cholesterol Test, Lipid Panel | $105 | N/A | $105 |
| Blood Test - Clotting Time | $53 | N/A | $53 |
| Blood Test - Coagulation Assessment | $75 | N/A | $75 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $81 | N/A | $81 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $99 | N/A | $99 |
| Blood Test - Comprehensive Metabolic Panel | $85 | N/A | $85 |
| Blood Test - Creatinine Level | $65 | N/A | $65 |
| Blood Test - Electrolytes Panel | $84 | N/A | $84 |
| Blood Test - Ferritin (Blood Protein) Level | $162 | N/A | $162 |
| Blood Test - Folic Acid Level | $29 | N/A | $29 |
| Blood Test - General Health Panel | $289 | N/A | $289 |
| Blood Test - Hepatic (Liver) Function Panel | $166 | N/A | $166 |
| Blood Test - Hepatitis B Surface Antibody Level | $36 | N/A | $36 |
| Blood Test - Hepatitis C Antibody Level | $55 | N/A | $55 |
| Blood Test - Iron Binding Capacity | $81 | N/A | $81 |
| Blood Test - Iron Level | $81 | N/A | $81 |
| Blood Test - Lead Level | $32 | N/A | $32 |
| Blood Test - Lipase (fat enzyme) Level | $76 | N/A | $76 |
| Blood Test - Magnesium Level | $82 | N/A | $82 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $105 | N/A | $105 |
| Blood Test - Thyroxine (Thyroid Chemical) Level, Free | $121 | N/A | $121 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $50 | N/A | $50 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $65 | N/A | $65 |
| Blood Test - Vitamin D-3 Level | $128 | N/A | $128 |
| Colonoscopy - Diagnostic (outpatient) | $4,292 | N/A | $4,292 |
| Developmental Screening | $16 | N/A | $16 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $263 | N/A | $263 |
| Emergency Department Visit - Low Complexity (outpatient) | $365 | N/A | $365 |
| Emergency Department Visit - Minor (outpatient) | $327 | N/A | $327 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $683 | N/A | $683 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $66 | N/A | $66 |
| Hydration Infusion | $173 | N/A | $173 |
| Lab Test - Creatinine Level | $65 | N/A | $65 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $42 | N/A | $42 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $164 | N/A | $164 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $62 | N/A | $62 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $107 | N/A | $107 |
| Lab Test - Detection test for Influenza Virus | $45 | N/A | $45 |
| Lab Test - Smear for Microorganism | $76 | N/A | $76 |
| Mammogram (outpatient) | $817 | N/A | $817 |
| Office Visit - Basic | $75 | N/A | $75 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $214 | N/A | $214 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $234 | N/A | $234 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $235 | N/A | $235 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $257 | N/A | $257 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $213 | N/A | $213 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $192 | N/A | $192 |
| Office Visit - Established Patient, High Complexity | $235 | N/A | $235 |
| Office Visit - Established Patient, Low Complexity | $119 | N/A | $119 |
| Office Visit - Established Patient, Moderate Complexity | $174 | N/A | $174 |
| Office Visit - New Patient, Low Complexity | $172 | N/A | $172 |
| Office Visit - New Patient, Minor | $164 | N/A | $164 |
| Pap Test, automated screening and manual rescreening | $132 | N/A | $132 |
| Pap Test, manual screening | $61 | N/A | $61 |
| Physical Therapy - Low Complexity Evaluation | $174 | 
Near Average
State Average: 1 | $174 |
| Physical Therapy - Manual Therapy | $90 |
Near Average
State Average: 4 | $90 |
| Physical Therapy - Moderate Complexity Evaluation | $259 |
Near Average
State Average: 1 | $259 |
| Physical Therapy - Self-care or Home Management Training | $87 | 
Above Average
State Average: 1 | $87 |
| Physical Therapy - Therapeutic Exercises | $90 |
Near Average
State Average: 4 | $90 |
| Physical Therapy - Ultrasound Therapy | $79 |
Above Average
State Average: 3 | $79 |
| Psychiatric Diagnostic Evaluation | $204 |
Near Average
State Average: 1 | $204 |
| Psychotherapy - 30 Minutes | $84 |
Near Average
State Average: 1 | $84 |
| Psychotherapy - 45 Minutes | $114 | 
Below Average
State Average: 4 | $114 |
| Psychotherapy - 60 Minutes | $159 |
Below Average
State Average: 5 | $159 |
| Psychotherapy - Group Session | $194 |
Above Average
State Average: 5 | $194 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $74 | N/A | $74 |
| Ultrasound - Abdominal, Limited | $1,124 | N/A | $1,124 |
| Ultrasound - Transvaginal (non-maternity) | $1,559 | N/A | $1,559 |
| Urine Test - Automated with Microscope Examination | $74 | N/A | $74 |
| Urine Test - Automated without Microscope | $42 | N/A | $42 |
| Urine Test - Bacterial Culture | $56 | N/A | $56 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $42 | N/A | $42 |
| Urine Test - Chlamydia | $105 | N/A | $105 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $105 | N/A | $105 |
| Urine Test - Microalbumin (Protein) Level | $65 | N/A | $65 |
| Urine Test - Pregnancy | $77 | N/A | $77 |
| Urine Test - Urinalysis, Manual Test | $42 | N/A | $42 |
| Vaccine - Influenza for Injection into Muscle | $37 | N/A | $37 |
| X-Ray - Abdomen | $450 | N/A | $450 |
| X-Ray - Ankle (outpatient) | $394 | N/A | $394 |
| X-Ray - Chest (outpatient) | $673 | N/A | $673 |
| X-Ray - Foot (outpatient) | $630 | N/A | $630 |
| X-Ray - Knee (outpatient) | $530 | N/A | $530 |
| X-Ray - Shoulder (outpatient) | $439 | N/A | $439 |
| X-Ray - Wrist (outpatient) | $603 | N/A | $603 |
