| Arthrocentesis (outpatient) | $1,820 | N/A | $710 |
| Arthroscopic Shoulder Surgery | $55,426 | N/A | $21,616 |
| Bacterial Culture - Aerobic Isolates | $83 | N/A | $32 |
| Bacterial Culture - Swab | $111 | N/A | $43 |
| Biopsy - Breast | $6,427 | N/A | $2,507 |
| Biopsy - Endometrial (Uterus) | $1,578 | N/A | $615 |
| Blood Test - Basic Metabolic Panel | $114 | N/A | $45 |
| Blood Test - Blood Glucose (Sugar) Level | $51 | N/A | $20 |
| Blood Test - Blood Typing (ABO) | $64 | N/A | $25 |
| Blood Test - Blood Typing (Rh (D)) | $64 | N/A | $25 |
| Blood Test - C-reactive Protein (CRP) Level | $105 | N/A | $41 |
| Blood Test - Cholesterol Test, Lipid Panel | $138 | N/A | $54 |
| Blood Test - Clotting Time | $78 | N/A | $30 |
| Blood Test - Coagulation Assessment | $93 | N/A | $36 |
| Blood Test - Complete Blood Cell Count (Hemoglobin) | $76 | N/A | $29 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $103 | N/A | $40 |
| Blood Test - Comprehensive Metabolic Panel | $213 | N/A | $83 |
| Blood Test - Creatinine Level | $54 | N/A | $21 |
| Blood Test - Electrolytes Panel | $80 | N/A | $31 |
| Blood Test - Ferritin (Blood Protein) Level | $140 | N/A | $54 |
| Blood Test - Folic Acid Level | $158 | N/A | $61 |
| Blood Test - Hepatic (Liver) Function Panel | $93 | N/A | $36 |
| Blood Test - Hepatitis B Surface Antibody Level | $110 | N/A | $43 |
| Blood Test - Hepatitis C Antibody Level | $137 | N/A | $53 |
| Blood Test - Iron Binding Capacity | $120 | N/A | $47 |
| Blood Test - Iron Level | $66 | N/A | $26 |
| Blood Test - LDL Cholesterol Level | $95 | N/A | $37 |
| Blood Test - Lead Level | $124 | N/A | $48 |
| Blood Test - Lipase (fat enzyme) Level | $118 | N/A | $46 |
| Blood Test - Magnesium Level | $69 | N/A | $27 |
| Blood Test - Pregnancy (Obstetric) Panel | $488 | N/A | $190 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $148 | N/A | $58 |
| Blood Test - Renal (Kidney) Function Panel | $111 | N/A | $43 |
| Blood Test - Thyroglobulin (Thyroid Protein) Antibody Level | $143 | N/A | $56 |
| Blood Test - Thyroid Stimulating Hormone (TSH) Level | $179 | N/A | $70 |
| Blood Test - Triiodothyronine (T3) Thyroid Hormone Measurement | $249 | N/A | $97 |
| Blood Test - Vitamin B-12 (Cyanocobalamin) Level | $179 | N/A | $70 |
| Blood Test - Vitamin D-3 Level | $302 | N/A | $118 |
| Bone Density Scan (outpatient) | $621 | N/A | $242 |
| Colonoscopy - Diagnostic (outpatient) | $6,184 | N/A | $2,412 |
| Colonoscopy - With Biopsy (outpatient) | $8,471 | N/A | $3,304 |
| Colonoscopy - With Polyp Removal (outpatient) | $8,932 | N/A | $3,484 |
| CT Scan - Abdomen and Pelvis, with Contrast | $6,267 | N/A | $2,444 |
| CT Scan - Chest, with Contrast (outpatient) | $3,927 | N/A | $1,532 |
| CT Scan - Head/Brain, without Contrast | $2,518 | N/A | $982 |
| Developmental Screening | $28 | N/A | $11 |
| Electrocardiogram (ECG or EKG), Tracing | $917 | N/A | $357 |
| Electrocardiogram (ECG or EKG), with Report and Interpretation | $363 | N/A | $142 |
| Emergency Department Visit - Low Complexity (outpatient) | $450 | N/A | $176 |
| Emergency Department Visit - Minor (outpatient) | $357 | N/A | $139 |
| Emergency Department Visit - Moderate Complexity (outpatient) | $873 | N/A | $340 |
| Evaluation of Antimicrobial Drug (antibiotic, antifungal, antiviral) | $106 | N/A | $41 |
| Fetal Non-Stress Test | $1,834 | N/A | $715 |
| Gall Bladder Surgery (outpatient) | $25,186 | N/A | $9,822 |
| Hydration Infusion | $281 | N/A | $110 |
| Lab Test - Creatinine Level | $95 | N/A | $37 |
| Lab Test - Detection for Strep (Streptococcus, group A) | $88 | N/A | $34 |
| Lab Test - Detection test for Coronavirus (COVID-19) | $386 | N/A | $151 |
| Lab Test - Detection test for Hepatitis B Surface Antigen | $106 | N/A | $41 |
| Lab Test - Detection test for Human Papillomavirus (HPV) | $267 | N/A | $104 |
| Lab Test - Detection test for Influenza Virus | $122 | N/A | $48 |
| Lab Test - Smear for Microorganism | $61 | N/A | $24 |
| Mammogram (outpatient) | $737 | N/A | $287 |
| MRI - Back (outpatient) | $3,382 | N/A | $1,319 |
| MRI - Brain (outpatient) | $5,359 | N/A | $2,090 |
| MRI - Knee (outpatient) | $3,628 | N/A | $1,415 |
| MRI - Pelvis (outpatient) | $6,457 | N/A | $2,518 |
| MRI - Shoulder, Elbow, or Wrist | $3,942 | N/A | $1,537 |
| Myocardial Imaging (outpatient) | $7,582 | N/A | $2,957 |
| Office Visit - Basic | $69 | N/A | $27 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 1-4 Years Old | $228 | N/A | $89 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 12-17 Years Old | $303 | N/A | $118 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | N/A | $90 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | N/A | $105 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 5-11 Years Old | $227 | N/A | $88 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, Younger than 1 Year Old | $224 | N/A | $87 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 1-4 Years Old | $191 | N/A | $75 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 12-17 Years Old | $209 | N/A | $81 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $213 | N/A | $83 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $227 | N/A | $88 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 5-11 Years Old | $190 | N/A | $74 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, Younger than 1 Year Old | $195 | N/A | $76 |
| Office Visit - Established Patient, High Complexity | $252 | N/A | $98 |
| Office Visit - Established Patient, Low Complexity | $186 | N/A | $72 |
| Office Visit - Established Patient, Moderate Complexity | $219 | N/A | $86 |
| Office Visit - New Patient, Low Complexity | $300 | N/A | $117 |
| Office Visit - New Patient, Minor | $230 | N/A | $90 |
| Office Visit - New Patient, Moderate Complexity | $400 | N/A | $156 |
| Pap Test, automated screening and manual rescreening | $271 | N/A | $106 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 
Below Average
State Average: 3 | $20 |
| Physical Therapy - Application of Hot or Cold Pack | $65 |
Below Average
State Average: 3 | $25 |
| Physical Therapy - Electrical Stimulation Therapy | $79 | 
Near Average
State Average: 3 | $31 |
| Physical Therapy - High Complexity Evaluation | $468 |
Near Average
State Average: 1 | $183 |
| Physical Therapy - Low Complexity Evaluation | $235 |
Near Average
State Average: 1 | $92 |
| Physical Therapy - Manual Therapy | $122 | 
Above Average
State Average: 4 | $48 |
| Physical Therapy - Moderate Complexity Evaluation | $352 |
Near Average
State Average: 1 | $137 |
| Physical Therapy - Neuromuscular Reeducation | $89 |
Below Average
State Average: 4 | $35 |
| Physical Therapy - Self-care or Home Management Training | $153 |
Near Average
State Average: 1 | $60 |
| Physical Therapy - Therapeutic Activities | $79 |
Below Average
State Average: 3 | $31 |
| Physical Therapy - Therapeutic Exercises | $122 |
Above Average
State Average: 4 | $48 |
| Physical Therapy - Ultrasound Therapy | $122 |
Near Average
State Average: 3 | $48 |
| Physical Therapy - Walking Training, 15 minutes | $122 |
Above Average
State Average: 1 | $48 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $60 | N/A | $23 |
| Ultrasound - Abdominal, Complete | $1,224 | N/A | $477 |
| Ultrasound - Abdominal, Limited | $728 | N/A | $284 |
| Ultrasound - Breast (outpatient) | $1,503 | N/A | $586 |
| Ultrasound - Head and Neck | $1,104 | N/A | $430 |
| Ultrasound - Pelvic (outpatient) | $1,164 | N/A | $454 |
| Ultrasound - Pregnancy (outpatient) | $744 | N/A | $290 |
| Ultrasound - Pregnancy Follow-Up | $518 | N/A | $202 |
| Ultrasound - Transvaginal (non-maternity) | $1,168 | N/A | $455 |
| Upper Gastrointestinal Endoscopy - With Biopsy | $10,755 | N/A | $4,195 |
| Urine Capacity Measurement | $581 | N/A | $226 |
| Urine Test - Automated with Microscope Examination | $81 | N/A | $32 |
| Urine Test - Automated without Microscope | $19 | N/A | $7 |
| Urine Test - Bacterial Culture | $64 | N/A | $25 |
| Urine Test - Bacterial Culture, Quantitative Colony Count | $84 | N/A | $33 |
| Urine Test - Chlamydia | $267 | N/A | $104 |
| Urine Test - Gonorrhoeae (Neisseria Gonorrhoeae Bacteria) | $267 | N/A | $104 |
| Urine Test - Microalbumin (Protein) Level | $95 | N/A | $37 |
| Urine Test - Pregnancy | $55 | N/A | $21 |
| Urine Test - Urinalysis, Manual Test | $27 | N/A | $11 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $197 | N/A | $77 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | N/A | $27 |
| X-Ray - Abdomen | $615 | N/A | $240 |
| X-Ray - Ankle (outpatient) | $739 | N/A | $288 |
| X-Ray - Chest (outpatient) | $651 | N/A | $254 |
| X-Ray - Foot (outpatient) | $748 | N/A | $292 |
| X-Ray - Hand | $823 | N/A | $321 |
| X-Ray - Hip | $645 | N/A | $251 |
| X-Ray - Knee (outpatient) | $877 | N/A | $342 |
| X-Ray - Neck, Cervical Spine | $814 | N/A | $317 |
| X-Ray - Pelvis | $926 | N/A | $361 |
| X-Ray - Shoulder (outpatient) | $810 | N/A | $316 |
| X-Ray - Spine (outpatient) | $867 | N/A | $338 |
| X-Ray - Wrist (outpatient) | $770 | N/A | $300 |
